LIBRARY OF CONGRESS. 

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UNITED STATES OF AMERICA. 



A TEXT-BOOK 



OF 



Practical Therapeutics, 



WITH ESPECIAL EEFEEENCE TO THE 



APPLICATION OF REMEDIAL MEASURES TO DISEASE 

AND THEIR 

EMPLOYMENT UPON A RATIONAL BASIS. 



/ BY 

HOBART AMORT HARE, M.D. (Univ. of Pa.),B.Sc, 

CLINICAL PROFESSOR OF THE DISEASES OF CHILDREN AND DEMONSTRATOR OF THERAPEUTICS IN THE 

UNIVERSITY OF PENNSYLVANIA ; PHYSICIAN TO ST. AGNES'S HOSPITAL AND TO THE MEDICAL 

DISPENSARY OF THE CHILDREN'S HOSPITAL ; LAUREATE OF THE ROYAL ACADEMY OF 

MEDICINE IN BELGIUM, OF THE MEDICAL SOCIETY OF LONDON, ETC. ; SECRETARY 

OF THE CONVENTION FOR THE REVISION OF THE PHARMACOPOEIA OF 1890. 



6 





T7>jy 



PHILADELPHIA: 
LEA BROTHERS & CO 

18 9 0. 



*- 



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**** 



Entered according to the Act of Congress, in the year 1890, by 

LEA BEOTHERS & CO., 
in the office of the Librarian of Congress. All rights reserved. 



DORNAN, PRIMER. 



THIS VOLUME 
IS DEDICATED TO 

Dr. J. WILLIAM WHITE, 

PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF PENNSYLVANIA, 

AS AN 

EVIDENCE OF FRIENDSHIP AND ESTEEM, 

BY 

THE AUTHOR. 



PREFACE. 



The object of this book is to provide the physician or undergraduate 
student of medicine with a reliable guide in the study of Therapeutics, 
or the application of remedial measures for the cure of disease. It has 
been written because, in the belief of the author, most of the text-books 
on this subject treat of it as if the student was already a skilled physician 
or experimental pharmacologist. As a consequence, two classes of under- 
graduate readers exist. One finds that the mixture of science and em- 
piricism is too difficult for him to fathom, and is hopelessly confused ; 
the other simply learns the remedies and doses by heart and gives drugs 
with little idea as to what they are to do. Further than this, the physi- 
cian is often at a loss to decide when a remedy is indicated, even though 
his theoretical knowledge of the subject be very thorough. Thus, he is 
told that ammonium chloride is a remedy in bronchitis, but the exact stage 
at which it is to be employed is often not stated, or he knows that digitalis 
does good in cases of cardiac disease, but fails to recognize the fact that it 
is only when compensation is lacking that the drug is needed. For this 
reason Part IV. has been written, not with the object of providing a 
rigid system for treating disease, but rather for the purpose of bringing 
together the best remedies, and of showing how and why they are given. 

Rational therapeutics at the present day does not consist in a knowl- 
edge of doses and the materia medica, but exists as a complex art in which 
knowledge and its proper application, based on common-sense principles, 
go hand-in -hand. The treatment of "symptoms as they arise" by 
the employment of remedies recommended by some eminent authority is 
a variety of empiricism whose existence has depended largely on the fact 
that many physicians of the past have either been so ignorant as to be 
led where a writer willed, or so slothful as to be willing to let others 
think for them. Scientific research has so largely opened up to every- 
one the possibility of using drugs with a distinct idea of the reason 
for their employment, that the writer has endeavored to bring together 
in a readable form the combined results of laboratory and bedside 
experience, thinking the time ripe for such a task, It is true that 
several other books give, in a more or less thorough manner, a resume 
of the physiological action of the drugs of which they treat, but in even 
the best of them only the most trained student of pharmacology can dis- 
cover the close relationships which exist between the results reached by 
the physiologist on the one hand and the clinician on the other. The 
two parts of the study are usually so divorced by the prolonged mental 
effort necessitated by the arrangement of the text, that the student 



VI PREFACE. 

either ignores the physiological action for the sections on therapeutics or 
crams the former to pass an examination required by the teacher whose 
course he must follow. As a consequence, too many ]}hysicians regard 
pharmacology simply as a species of mental training, or believe it to be 
a waste of time and energy. No one can think that the writer of this 
book will ever deny the value of original research or bedside experience, 
but he does desire to weave science and practice into so close a network 
that the foundations of experience may be cemented by the mortar of 
exact knowledge. In some instances, however, science and practice 
seem to be absolutely opposed and only future research can explain the 
apparent contradiction. 

Throughout this book, in every part where drugs or diseases are con- 
sidered, the writer has arranged the titles in alphabetical order, accord- 
ing to their English names. This has been done because it is desired 
to afford the reader a ready-reference book to which he may turn at 
short notice for desired information, for at present the state of pharma- 
cology is so unsettled that a true classification is impossible. Thus, 
morphine may be classed by one writer as a nervous sedative, by another 
as a sleep-producer, by a third as a bitter substance, and by a fourth as 
a respiratory depressant. Bromide of potassium can, with equal pro- 
priety, be called a spinal sedative or a cerebral sedative, or caffeine be 
classed as a cerebral stimulant, a circulatory stimulant, or a diuretic. 

In order to make the book more complete, the preparations of the 
British Pharmacopoeia have been introduced ; and with the same object 
in view, a dose-list of drugs, both officinal and unofficinal, has been ap- 
pended for ready reference. The subject of medical electricity has here- 
tofore commonly found a place in most text-books on therapeutics, but has 
been advisedly omitted in this instance, since electrical therapeutics has 
outgrown any work save one devoted to that subject alone. 

For many of the articles on treatment the author wishes to thank 
friends who have earned prominence in connection with their specialties. 
Thus Dr. G. E. de Schweinitz has contributed the articles on the treat- 
ment of diseases of the eye ; Dr. Edward Martin those on the treatment of 
venereal diseases and on antisepsis ; Dr. Barton C. Hirst those on the 
treatment of diseases of the puerperal state; and Dr. J. Howard Reeves, 
the articles on the treatment of diseases of the upper air-passages. All 
of these articles enhance the value of the book to so great an extent that 
the author feels sure they will be sought out and read with interest. 

In addition to the general index, a copious and explanatory index of 
diseases and remedies has been appended, which will prove suggestive 
and valuable to practitioners, and for which the author is indebted to 
his friend and student, Mr. J. G. Clark. 

Philadelphia, 222 South Fifteenth Street. 
September, 1890. 



CONTENTS 



PART I. 

*?-• paoi: 

General Therapeutic Considerations 17-28 

PART II. 

Drugs . . . . . . 29-296 

PART III. 

Remedial Measures other than Drugs 297-327 

Foods for the Sick 328-334 

PART IV. 

Diseases 335-572 

Table of Doses and Remedies . . . . . . . 573-580 

Index of Drugs and Remedial Measures .... 581-596 

Index of Diseases and their Treatment .... 597-632 



PART I. 

GENERAL THERAPEUTIC CONSIDERATIONS. 



Before entering into a study of the action of drugs upon the 
living body, it is necessary that the student possess a clear idea of 
what the word " therapeutics " means, the reason why we resort to 
drugs, and, more important than all, that he grasp the limitations 
which govern the administration of remedies. Two very foolish and 
unfounded ideas have recently been put forward by certain physicians 
— namely, that medical therapeutics is useless, and that this branch 
of medical knowledge is not advancing with as great a stride as 
pathology or surgery. The individuals who laugh at the general 
use of drugs in disease beloug to one of two classes — either they have 
never tried them, or if so have used the drugs ignorantly or wrongly, 
or they believe that they are promulgating a new theory, and do not 
know that both the era of excessive doses and nihilism are relics of 
the past. No reform has ever yet attacked a crying evil without 
becoming excessive and absurd itself, and, if successful in accom- 
plishing its object, has generally resulted not in the mere relief of 
the existing faults, but caused so complete a reversal of popular 
opinion as to force its converts into foolish ways as uncalled-for as 
their first acts. In exactly the same manner that the excesses of 
Catholicism resulted in fanatical Puritanism, so did the careless 
methods of physicians during the past century lay the foundation 
for the growth of homoeopathy or therapeutic nihilism. At the 
present time, although we have much to learn, it can be said that 
we have benefited by both of these errors, and are in consequence 
taking the path which may be considered a happy medium. 

To the majority of the readers of this book the harmfulness of 
over-dosing is evident, and the cry of " no drugs at all " is so 
absurd, that no rebuttal need be offered. 

The statement that therapeutics is more backward than pathology 
and surgery is readily answered and denied, for the therapeutist is 
able to treat successfully many diseases of which the pathologist 
knows nothing, and is obliged to rest his treatment on empiricism 
simply because he cannot tell how his drugs act if the pathologist 

2 



18 GENERAL THERAPEUTIC CONSIDERATIONS. 

cannot tell him what the disease is. Rheumatism is a good example 
of this very point. 

In regard to surgery, every one must recognize the extraordinary 
advances made in this branch of medical science, yet comparatively 
few realize that it is solely by the introduction of drugs that all these 
triumphs are possible. The definition of the word " therapeutics " 
in Billings's Dictionary is "that branch of medical science which 
treats of the application of remedies to the cure or alleviation of 
disease/' and practically the term is universally used to signify the 
employment of drugs for such purposes. The credit for the intro- 
duction of new instruments may or may not be accorded to surgery, 
but the invention of new drugs must be accorded to therapeutics. 
We find, then, that ether and chloroform began to revolutionize sur- 
gery fifty years ago, aud that corrosive sublimate, carbolic acid, and 
other drugs have revolutionized it once more in the lifetime of every 
one who reads this book. Cocaine has changed the entire face of eye 
surgery and other minor operations, and has immediately put aside an 
enormous amount of pain and suffering which the surgeon could not 
relieve, or at most remove, unless its influence was present. To the 
accusation of backwardness the therapeutist can well ask any part 
of medical science to put forward one discovery which equals anti- 
pyrine or acetanilide in power in the relief of disease or pain, or 
which can be applied to so wide a scope of ailments as specifics. 

In the language of one of the most progressive medical men ot 
to-day in the United States, the man who does not believe in the 
proper use of drugs for the cure of disease must lack the very key- 
stone of the arch upon which rests all medical knowledge. 

The ultimate aim and object of all medical thought and effort is 
the cure or alleviation of disease, and therapeutics is the refined pro- 
duct culled from every part of medical learning. Like every other 
thing requiring a thorough knowledge of its component parts, it is 
often much abused by the careless and ignorant, but is a power for 
good in the trained hand of the well-educated physician. 

Further than this, therapeutics is the only universally used branch 
of medicine in existence, for each and every branch resorts to it, and 
the most skilful operator who fails to treat his cases medicinally 
with equal skill has worse results than the man who bungles, but 
uses drugs intelligently after his slashing is finished. 



MODE OF ACTION OP DRUGS. 

Drugs act in two ways, which are sometimes called near and 
remote, direct or indirect. The near or direct action of a drug is 
that influence which is felt by the exercise of its effects directly upon 
the tissues with which it comes in contact ; the indirect or remote 



MODES OF ADMINISTERING DRUGS. 19 

influence is that result which comes as a sequence of its primary 
effect. As an illustration of this we may take the local use of can- 
tharides. The local, near or direct effect of this is a blister, the re- 
mote or indirect effect is the absorption of exudations or the influ- 
encing of inflammatory processes. If pilocarpin is used its direct 
effect is the sweating which ensues, while its indirect effect is the 
relief of dropsy. 

MODES OF ADMINISTERING DRUGS. 

Drugs may be used to affect the general system in many ways, 
but practically we only employ six methods, as follows : 

1 . By the mouth or stomach. 

2. By the rectum. 

3. By inhalation. 

4. By hypodermic injection. 

5. By inunction. 

6. By the endermic method. 

By far the most usual manner of administering drugs is by way of 
the mouth, which is the most natural means of entrance into the body 
for foreign substances. Whenever medicines are used in this way, 
the physician should clearly bear in mind what the medicine is to do 
after it is swallowed. Thus, if the drug is intended to act directly 
upon the stomach it should not be given after meals, but a little 
while before, since the food and gastric juice may afterward so cover 
the gastric mucous membrane that the medicament cannot act. Thus, 
in the case of chronic gastric catarrh or gastric ulcer the nitrate of 
silver which is used should always be given half an hour before 
meals. On the other hand, if an ulcer or other trouble exist in the 
small intestine, the pill should be given some time after meals, and 
if a heavy meal is taken, three or four hours after, since under these 
circumstances the medicine is swept out into the intestine almost at 
once, without remaining any time in the stomach where it may be 
chemically altered. Very often it is necessary to give a medicine 
after food is taken, in order that it may not act in too powerful or 
concentrated a manner upon the viscus which receives it. 

The general rule, however, may be laid down that all medicines 
are to be taken after rather than before meals unless a local gastric 
effect or very rapid absorption is desired. 

When drugs are given by the rectum, we employ them for three 
purposes. Namely, to influence the general system by their absorp- 
tion, to act locally upon any disease which may be present in this 
particular locality, and, finally, to dislodge substances or parasites 
which it is desired to bring away. The word enema is loosely used 
to denote all these injections, be their purpose what they may, and 



20 GENERAL THERAPEUTICAL CONSIDERATION'S. 

is synonymous with " rectal injection " or the more old-fashioned 
word clyster. If nourishment is being given the injection is called 
a " nutrient enema." Sometimes these injections are called lave- 
ments. 

It is very necessary that the physician should use his medicines in 
such an instance in proper bulk, and it may be laid down as a rule 
that no more liquid should be injected than is necessary to carry the 
medicine or food unless the injection is for the purposes of emptying 
the bowel of faecal matter or other materials, or it is desired to dis- 
tend the colon to overcome obstruction or to influence chronic 
colitis. 

The reason for this lies in the fact that any large bulk of liquid 
sent into the rectum so stimulates its walls by distention as to cause 
spasmodic contraction and expulsion of all the rectal contents, which 
is just what is needed where faecal matter is to be removed, but the 
opposite of what is desired where retention is necessary for absorp- 
tion or local action of a remedy or food. In rectal catarrh or ulcer 
two to four ounces of liquid are usually sufficient in an adult to 
accomplish any medicinal influence locally or by absorption, while 
one to two pints may be employed as a laxative enema. 

In the use of injections we frequently find that the rectum 
becomes irritable, and at once resists all efforts to force the entrance 
of liquids or solids. This is to be avoided by giving the injection 
so gently that the bowel fails to recognize the entrance of liquid and 
by the introduction of a few drops of oil and laudanum in each injec- 
tion. 

Suppositories are another means by which we introduce medicines 
into the bowel for local effect, or to act after absorption of their, 
contents upon the general system. 

When drugs are given by inhalation they are generally employed 
with the object of affecting the respiratory tract alone, although 
there are notable exceptions to this in ether, chloroform, nitrous oxide 
gas, and other volatile substances. Aside from anaesthetics, we find 
that remedial measures may be taken by means of steam laden with 
the drugs employed, by the respiring of air loaded with the fumes of 
the medicament, or by the inhalation of gases. Last, and most com- 
monly resorted to of all, we find the atomizing spray, which, if prop- 
erly made and employed, so minutely divides the liquid containing 
the medicine that the inspired air carries it to the furthest bronchiole 
and pulmonary vesicle. 

As examples of the rules governing the administration of drugs in 
this manner, we find that compound tincture of benzoin may be taken 
by inhaling the steam arising from hot water containing it, but cannot 
be used in a spray because it occludes the fine points of the tubes. In 
a similar manner we inhale the smoke of belladonna or tobacco leaves 
to relieve asthma, or the fumes of chloride of ammonium for bron- 



MODES OF ADMINISTERING DRUGS. 21 

chitis in its later stages. Finally, we find that oxygen is an exceed- 
ingly useful gas, readily inhaled with good results in proper cases. 

The spray or atomizer as used is made in a number of forms ; one 
class being worked through the agency of compressed air, the other 
through the escape of steam from a small boiler. Very few of the 
compressed air atomizers throw a fine enough spray to reach the 
lower parts of the lung, particularly if the air is compressed by the 
hand. 

The inhalation of moist air is very useful in bronchitis, and 
greatly aids other measures directed to its cure. Steam may be dis- 
engaged in the room by means of a boiling kettle, or by placing pieces 
of unslaked lime in a pan of water. 

Next to the use of drugs by the mouth, by far the most popular 
method is their administration by means of the hypodermic needle 
and syringe. The logic of this method rests upon the absorption 
of all soluble substances from the cutaneous tissues with great 
rapidity. Any substance soluble enough or suspendable enough to 
pass through a hypodermic needle without forming an obstruction 
may be employed, provided it is not too irritating and is clean. 

The proper places to give such injections are the forearm, on either 
surface, the calf of the leg, the buttock or the broad of the back, 
or, in other words, any spot where the tissues are not dense and un- 
yielding. The skin of the part is to be grasped or pinched up with 
the thumb and forefinger of the left hand and the needle sent well 
into this raised fold, preferably above the finger and thumb, so that 
the pressure of these two may prevent pain and the too rapid 
entrance of the medicine into the system. The needle should always 
penetrate well into the loose connective tissue so that the liquid in- 
jected may find lodgment in the loose and spongy subcutaneous 
tissues without separating the skin from its rather close adhesion to 
the tissues below and to the bloodvessels supplying it, which if done 
may result in abscess and a slough. 

The dangers from hypodermic injections are chiefly two : First. 
The medicine may enter a vein, owing to the penetration of the wall 
by the needle, and the entire dose be taken at once, en masse, to the 
vital centres. Second. The solution used may not be sterile or the 
needle dirty, and an abscess may result. The first danger is to be 
avoided by injecting into spots not well supplied with veins, and the 
second by thoroughly washing both the syringe and needle with water 
the instant that they are used, pushing a fine wire through the needle 
and in some cases by soaking it in carbolized oil. Further than 
this, the liquid injected may be rendered sterile by using freshly boiled 
water and adding thereto carbolic acid in such proportion that half 
to one drop of carbolic acid is present in each injection. Most hypo- 
dermic syringes hold from twenty to thirty minims. 



22 GENERAL THERAPEUTICAL CONSIDERATIONS. 

Inunctions consist in the rubbing into the skin of medicines 
generally of an oily or fatty nature, or which are made to have this 
characteristic through embodiment with oil or fat. The three sub- 
stances most commonly used in this way are cod-liver oil, mercurial 
ointment, and iodine ointment. They should always be rubbed in 
on some part of the skin where the derm is thin and well supplied 
with subcutaneous lymphatics, as in the axilla?, the groins, or the 
inside of the thighs. Other substances have been and may be used 
by inunction, but as the method is necessarily a disagreeable and 
dirty one, it is rarely resorted to unless the stomach is disordered or 
it is necessary to push the drug into the system by every possible 
point of entrance. 

The endermic method consists in the previous use of a blister by 
means of which the epiderm being raised a little morphine or other 
alkaloid may be slipped under it and so absorbed from the true skin. 
It is a painful, almost never to be resorted to method, which has 
been entirely supplanted by the hypodermic method of medication. 

Remedies are administered in a number of forms, but chiefly as 
follows : 

Abstracts are dry powdered extracts mixed with sugar of milk 
until they are twice as strong as the crude drug ; only eleven of them 
are officinal. 

Aceta, or vinegars, are solutions of drugs in vinegar or acetic 
acid. There are four in the United States Pharmacopoeia and three 
in the British. 

Alkaloids are organic bases generally occurring in crystalline 
form and abstracted from crude drugs. They represent nearly 
always the active principle of the drug. 

Aqile, or waters, are used as vehicles either for the dilution of 
strong medicines, or for the purpose of carrying minute amounts of 
flavoring materials. They are used chiefly as vehicles. 

Cataplasms are not officinal in the United States Pharmacopoeia, 
but are in the British Pharmacopoeia. They are virtually poultices 
made of linseed-meal or of bread crumbs. 

Cerates are ointments containing wax to render them harder 
than ordinary fats would allow. 

Charts, or papers, consist in bibulous paper soaked in a solu- 
tion of the drug which they are meant to carry. 

Confections are sometimes called electuaries or conserves, and 
are soft pastes which contain the drug mixed with sugar or honey. 

Decoctions are solutions of drugs made by boiling and then 
straining while hot. 

Elixirs are diluted tinctures rendered pleasant to the taste by 
the addition of aromatic substances and sugar. 

Emplastra, or plasters, are made up of adhesive substances 



DOSAGE. 23 

placed upon a backing of cloth or leather and designed to adhere 
to the skin over a diseased area ; being put there for the purpose of 
holding a medicinal substance in contact with the body, of acting as 
a protective, or to aid in the approximation of the edges of a 
wound. 

Extracts consist of the soluble parts of plants reduced to a 
semi-solid or solid condition by evaporation ; the soluble constituents 
being taken from the plant by water or alcohol. 

Fluid extracts are made in the same way as solid extracts, 
except that they are not so completely evaporated. 

Glycerita, or glycerins, are solutions of various substances in 
glycerin ; the glycerin being used as a vehicle. 

Infusions are made by pouring boiling water on the crude drug 
and allowiug it to stand for a short time until the water cools, after 
which the liquid is strained. Sometimes cold water is employed. 

Pills are small round masses which, as a general rule, should 
never contain more than three grains, in order to avoid being too 
bulky. If the material is a heavy one, as much as five grains may 
be placed in each pill. 

Suppositories are small round masses made into a cone shape, 
having for their basis cocao butter, and are designed to carry into the 
rectum certain medicines for absorption or for local action. 

Tinctures are solutions of the active principles of drugs in 
alcohol. 

Triturates are made by adding ten per cent, of the active medi- 
cine to ninety per cent, of milk-sugar. These are then carefully 
rubbed together until the two are intimately mixed. 

Troches, or lozenges, are flat, hardened masses designed for hold- 
ing mediciues in the mouth so that they may be slowly dissolved, 
thereby affecting the local mucous membrane. 

Ointments consist in the mixture of some kind of fatty substance 
with the medicine which they are designed to carry. 

Wines are made in the same way as tinctures; strong white wine 
being used in the United States and sherry or orange wine in Great 
Britain in place of ordinary alcohol. 



DOSAGE. 

There is, unfortunately, no absolutely fixed rule which can be 
applied to dosage for several reasons. In the first place, the indi- 
vidual may not be readily affected by drugs, or the disease process 
which is present may so antagonize them as to render very large 
doses necessary. Further than this, the age and sex of a patient have 
much to do with the regulation of the proper amount of drug which 
we may give, and, finally, that curious unknown subject of suscep- 



24 GENERAL THERAPEUTICAL CONSIDERATIONS. 

tibility to various remedies, that we call idiosyncrasy, creeps in as an 
important factor in the decision as to the dose which should be given 
in each case. By far the nearest approach which we can make to 
absolute accuracy in dosage, is to use drugs according to the weight 
of the patient, but this method possesses the disadvantage that we 
cannot always weigh our patients, and that the presence of a large 
amount of fat or of dropsy will make an unknown quantity in our 
calculation as to the true weight of the active part of the individual. 

At present we are accustomed to be governed by a list of doses 
which is given to all adults within certain limitations, and which are 
varied sufficiently to allow great difference in the effects obtained, 
and it is in this very point that the success of many a physician 
chiefly rests, for the use of a dose by rule of thumb is as empirical 
and lacking in thought as is the use of a remedy, not because we 
have a definite action for it to carry out, but because it did some one 
else good who was suffering from what appears to be a similar 
attack. The dose must be varied to fit the case in the same manner 
that the cut of a coat must be varied to fit each individual. 

There are a number of rules iu regard to the doses which are given 
to children, the best of which is Young's rule. This is as follows : 

Add 12 to the age and divide by the age. Thus, if a child is 2 
years old, we have the following fraction : 2 -f 12 = 14, -=- by 2 = 7 
or one-seventh of the dose for an adult is the dose for a child of 2 
years. This rule is not a law, however, for of narcotics children 
receive less than this (one-half), and of purgatives or laxatives more 
than this (two or three times). 

When drugs are given hypodermically the dose should be generally 
one-half to one-quarter of the dose by the mouth, and if any thought 
of idiosyncrasy exists, the dose should be* smaller still at the start, 
provided powerful remedies are to be used. 

By the rectum the dose should be twice the amount given by the 
mouth, unless the drug be very powerful. 



IDIOSYNCRASY. 

This is one of the most interesting portions of the study of the 
action of drugs, a frequent cause of disappointment to patient and 
doctor, and an equally frequent cause of excessive action from what the 
physician has thought to be a moderate dose. No rule can be laid 
down for the discovery of its existence in a given case, except that 
females, particularly of the hysterical type, are more subject to idio- 
syncrasy than males, although certain men often present marked 
evidences of this tendency. ~No better illustration of idiosyncrasy 
can be adduced than the case which is appended, nor than that of a 



IDIOSYNCRASY. 25 

friend of the author, who cannot eat a strawberry without suffering 
from a violent attack of hives. 

The other case is that of a woman of thirty years, suffering from 
severe headache, who received an eighth of a grain of the muriate of 
piJocarpin, hypodermically, every twenty minutes, till nearly three- 
fourths of a grain was taken, without any evidence of its action either 
in salivary flow or sweat. But the tolerance of drugs did not stop here. 
Twenty drops of tincture of cannabis indica every four hours failing 
to relieve the pain, half-grain pills were ordered of the solid extract of 
the drug which was known to be reliable, two of which commonly 
affect a grown man most markedly. In order to avoid any failure in 
absorption the pills were cut in half before they were given, and forth- 
with administered, one every three hours, without any effect after 
ten had been taken. Twenty more of the pills from the same manu- 
facturers, but from a different retailer, were now given, one every 
hour, with the exception of a few irregularities in administration in 
the night, the entire twenty being swallowed between four o'clock 
one afternoon and two o'clock on the next afternoon. The thirty 
pills (15 grains) were taken in less than forty-eight hours without 
producing a single physiological sign of the slightest character. 

That the doses were really swallow r ed would seem to be undoubted 
for their administration was carried out by a trained attendant, and 
their black color forbade their expulsion on the bed from the mouth 
without attracting attention. The hypodermic injections were given 
by the author, and as the solution was made as fast as it was used, 
the patient must certainly have received all of the pilocarpin. 

As there was daily an afternoon rise of temperature amounting to 
several degrees, quinine bisulphate was ordered in the dose of fifteen 
grains to be given after six powders of one-sixth of a grain of calomel 
had been taken ; this not only failed to control the fever but also pro- 
duced no buzzing in the ears. The writer was now inclined to con- 
sider all the symptoms as hysterical, even including the evening rise 
of temperature. 

Twenty-four hours after the last dose of cannabis indica, the at- 
tendant gave the patient, without orders, no less than sixty grains ot 
antipyrine in sixteen hours without any physiological symptoms, and, 
under orders, she took from forty to fifty grains of bisulphate ot 
quinine every day for three days without any signs of cinchonism. 

Wide experience has taught us, however, that several conditions 
act fairly constantly in regard to some idiosyncrasies. Certain dis- 
eases — such as peritonitis or pain — allow large doses of opium to be 
given, or in lead -poisoning and paralysis patients may require enor- 
mous doses of active purgatives to move the bowels. 

The climate in which the patient lives, or has been accustomed to 
live, renders him more or less susceptible to certain remedies. Thus 
the East Indian runs amuck after eating hasheesh or cannabis indica, 



26 GENERAL THERAPEUTICAL CONSIDERATIONS. 

or the Chinaman goes into a delightful dream-land from smoking 
opium, whereas the Anglo-Saxon experiences no such agreeable sen- 
sations as a general rule. Southerners generally require larger doses 
of purgatives than Northerners, oftentimes because their livers are not 
as active. 

The temperament of an individual is also a highly important 
matter to be considered. It is a notorious fact that phlegmatic dark- 
skinned persons usually yield to drugs less readily than blondes and 
nervous persons, more especially in respect to the drugs which act on 
the nervous system. Nervous light-haired women stand belladonna 
very badly as a general rule, while children will take large doses 
often without discomfort. Opium is usually badly borne by children. 

Habit is another important fact governing idiosyncrasy. We all 
know how rapidly one becomes accustomed to tobacco, and how mor- 
phine habitues take enormous amounts of their favorite drug without 
effect. 

ABSORPTION OF DRUGS. 

The knowledge of the rapidity with which certain drugs are 
absorbed from the various surfaces with which they come in contact, 
is of importance in order that we may know when to repeat the dose 
if the first amount does not produce the desired effect. The rapidity 
of absorption depends upon a number of factors. If the circulation 
is active absorption is active, but if it be depressed absorption is slow. 
Thus, in a person apparently drowned, absorption may not occur at 
all until the vital functions are restored, and repeated closes given to 
the patient while unconscious, acting together in the end, poison him. 
This is often the case in delirium tremens where hypodermic injec- 
tions of morphine are given, or when it is administered by the mouth. 
In dropsy absorption is peculiarly slow, and the drug may remain in 
the tissues for days, only to be absorbed with the exudation after 
severe purgation, or profuse diuresis or tapping. In general dropsies 
hypodermic medication is nearly always worse than useless. 

When the stomach or rectum is empty absorption is rapid, but 
when they are full it is very slow. For this reason we find the 
popular idea that a glass of whiskey when a man is hungry makes 
him drunk, whereas twice the quantity after dinner does not do so. 

Drugs in the stomach or bowel have no influence over the general 
system unless they are irritants. They only act when taken into 
the blood or lymphatics. 



DURATION OP ACTION OF DRUGS. 

The duration of action of drugs depends partly upon their rapidity 
of absorption, but chiefly upon the rapidity of their destruction in the 



INDICATIONS AND CONT R A-IN DIC ATIONS. 27 

body, or their elimination. Thus, volatile substances such as ether, 
chloroform, and nitrite of amyl, act only for a short time and are 
quickly eliminated, whereas bromide of potash and digitalis act over 
many hours, and are slowly eliminated in one case or oxidized, as in 
the second instance. Again, if curare is given hypodermically it will 
cause paralysis, but if taken by the stomach in moderate amount will 
be eliminated by the kidneys as rapidly as it is absorbed, and pro- 
duce no eifects if these organs are active. From studying the rapidity 
of the elimination of a drug we learn how often to order a dose. 
Thus, digitalis may be given once, twice, or thrice a day, but car- 
bonate of ammonium ought to be used every two or three hours. 

Whenever a drug is eliminated slowly and the physician is not 
careful in its use, it may suddenly develop so severe an effect as to 
cause alarm, owing to the accumulation of the poison in the body. 



INDICATIONS AND CONTRA-INDIOATIONS. 

The indication for a drug is any symptom or series of symptoms 
which w r e kuow the drug will relieve without causing at the same 
time any evil effect to be felt by other parts of the body. A contra- 
indication is any coexisting state or tendency which will be made 
so much worse by the drug as to forbid its use. Thus, one might 
be tempted to give quinine in meningitis for the fever, yet this would 
be bad therapeutics, since quinine would be contra-indicated, as it 
would make the meningitis worse. 

Cardiac stimulants, are contra-indicated in the presence of arterial 
excitement, and indicated in arterial depression. 

Cardiac sedatives are indicated in arterial excitement, contra-indi- 
cated in arterial depression. 

Nervous stimulants are contra -indicated in nervous excitement, 
indicated in nervous depression. 

Nervous sedatives are indicated and contra-indicated in a reverse 
manner to nervous stimulants. 

Astringents are contra-indicated as a rule in acute inflammations, as 
most of them are irritants when applied profusely. The exceptions 
to this rule are the salts of lead and silver and bismuth subnitrate, 
all of which are sedative astringents. 

Tonics are indicated in instances of local or general systemic de- 
pression, contra-indicated in cases of inflammation or excitation with 
excessive functional activity. 

Alteratives are indicated where cell-growth is active to excess, but 
contra-indicated where tissue break-down is present, or there exists 
a tendency thereto. 

Emetics are indicated w T hen we wish to unload the stomach of 



28 GENERAL THERAPEUTICAL CONSIDERATIONS. 

undesirable materials, or when we wish to cause an increased flow of 
bile from the gall-bladder, which is accomplished by the pressure 
exerted upon this viscus at the time that the abdominal walls and 
diaphragm contract in retching. Where the ducts are mechanically 
obstructed with a gall-stone emetics are dangerous, as they may cause 
rupture of the gall-bladder. 

Sometimes we are able to rid the lungs and stomach of mucus in 
bronchitis or gastric catarrh by emetics. 

The contra-indications are cerebral congestion or meningitis, as well 
as gastritis, gastric ulcer, advanced pregnancy, and hernia. 



COMBINATION OF DRUGS FOR A JOINT EFFECT. 

The study of the physiological action of drugs has aided us very 
greatly in improving our therapeutic measures. Thus we now know 
that chloral is a heart depressant and cannot be used in very full doses, 
or pushed to produce sleep in persistent insomnia without grave 
danger, whereas morphine, which also produces sleep but does not 
depress the heart but does depress the respiration, can be combined 
with it, and the two acting together, each in small dose, produce a 
heavy sleep, although so little chloral is present that the heart is 
safe, and so small an amount of morphine is used that the respiration 
does not suffer. 

Another example of this is found in certain purgative pills where 
the purgative agent is assisted by belladonna, which relaxes muscular 
spasm, and nux vomica, which acts as a tonic to the alimentary tract, 
all the drugs combining to accomplish one' result. 

Skill in the combination of drugs, not only for increased physio- 
logical effect but also for the purpose of making their administration 
pleasant to the taste, has much more to do with professional success 
than is generally supposed. This is particularly so in regard to 
children, for parents dislike forcing their children to take doses which 
they themselves regard as horrible, and they are ever ready to believe 
that as long as a medicine tastes good it is better than one which 
tastes otherwise. 

The medical practitioner who prescribes ever so wisely and appro- 
priately for a patient, but who is utterly regardless as to his combi- 
nations of drugs so far as taste is concerned, will sooner or later see a 
more ignorant man take from him that practice which his greater 
wisdom entitles him to, but which is driven from him by his own 
errors in this matter. 

While in some cases there is no alternative but to give a bad dose, 
in others a little thought and care will often avoid offending the taste 
of the patient. 



PART II 

DRUGS. 



ACACIA. 



Acacia, U. S., or Gum Arabic; Acacice Gummi, B. P., Gum 
Acacia, is a gummy exudate appearing on the stems and branches of 
small trees known as acacia vera and acacia Senegal or other acacias 
growing in northern Africa and Australia. As sold in the stores it 
consists of irregular semi-transparent lumps either smooth or angular, 
according to whether the exudate has been preserved in beads or 
broken by handling. The color is slightly yellow or almost white, 
the transparency and color depending largely on the amount of im- 
purities contaminating it. 

It is devoid of physiological action. 

Therapeutics. — Acacia is employed in medicine as a local applica- 
tion to inflamed and irritated mucous membranes, particularly of the 
upper air-passages, and in the form of a drink in these states. In 
instances where genito-urinary irritations exist it is useful as a vehicle 
for more powerful remedies. Made into a mucilage with flaxseed, 
to which liquorice may be added, it is largely employed to loosen a 
hacking cough in children and adults. The flaxseed should not be 
boiled, but allowed to stand on a moderately warm part of the 
"range," and the gum arabic solution added with a little lemon 
juice for flavoring purposes. Acacia is chiefly used in pharmacy for 
making pills, emulsions, and similar preparations, and is officinal in 
the form of the mucilage of acacia (Mucilago Acacice, U. S. and B. P.) ; 
and the syrup of acacia (Syrupus Acacice, U. #.),the first containing 
34 parts of acacia and 66 parts of water, and the second 25 parts 
of the mucilage to 75 of simple syrup. 



ACETANILIDE, OR ANTIFEBRIN. 

This substance, originally employed in medicine by Hinsberg and 
Kast, is a white crystalline material only slightly soluble in water 



30 DRUGS. 

but completely soluble in alcohol aucl ether. Applied to the tongue 
it causes a burning sensation which is not very severe. It has been 
known to chemists for many years, and is made by the action of 
glacial acetic acid upon aniline, forming in this way acetanilide or 
phenyl-acetamide. The word antifebrin is a trade-mark, and should 
not be used by the profession, since its employment forces the drug- 
gist not to use the acetanilide made by chemists, who are able to 
make the drug as an ordinary chemical compound, and do not charge 
so high a price as those holding control over the trade-mark name. 

Physiological Action. — Acetanilide has been studied experimentally 
and chemically to a very great extent, and fairly definite outlines of 
its action have been arrived at. 

Nervous System. — On the nervous system acetanilide has been 
found to act as a powerful sedative, the sensory part of the nerves 
and spinal cord being particularly quieted. In poisonous dose 
general anaesthesia comes on with total loss of reflex action and motor 
and sensory paralysis. The portions of the nervous system involved 
in these changes are primarily the sensory side of the spinal cord 
and the sensory nerves, the motor apparatus being least affected. 
The muscles are not influenced by the poison except indirectly. 

Circulation. — On the circulation antifebrin has but little direct 
influence except when it is used in poisonous dose. Applied to the 
frog's heart it at first increases its rate of beating and its force, but 
soon causes a weakening, ending in arrest in wide diastole. Upon 
the higher animals it causes in toxic dose an immediate fall of arterial 
pressure with a diminution in the size of the pulse-waves and all the 
evidences of cardiac and circulatory depression, notwithstanding the 
fact that death ensues from respiratory failure. The cause of this 
fall of blood-pressure is a direct depressing action on the heart asso- 
ciated with failure of the vaso-motor system, as asphyxia causes no 
rise in pressure. 

In medicinal dose it causes no circulatory changes of any moment. 
Sometimes the pulse-rate is increased, sometimes diminished. The 
tendency is, however, rather toward depression than stimulation. 

Blood. — The action of this drug upon the blood is more prominent 
than its influence upon any part of the body, causing this tissue, 
when used in large doses, to become brownish-red, decreasing its 
ozonizing and oxygen-carrying power, and, finally, reducing the 
haemoglobin to methaemoglobin to a very considerable extent. The 
question as to its influence upon the corpuscles is still somewhat 
undecided, some observers stating that these bodies are disorganized, 
while others assert that they remain intact. In moderately large 
poisonous doses it may not affect the corpuscles, but if its use in 
large amount be maintained for some days, or a single very large 
one is used, corpuscular destruction certainly occurs, free haemoglobin 
being set free in the urine. The normal alkalinity of the blood is 
decreased and the urine becomes dark and brownish in color, so that 



OR ANTIFEBRIN. 31 

the blood crystals of Teichraaiiu may be found in it. In medicinal 
doses the blood shows no changes except in cases where idiosyncrasy 
is present or the doses are excessive. Under these circumstances 
the blood becomes slightly more blue than normal in the arterial 
system. 

Respiration. — No effect is produced upon this function in moder- 
ate doses. When poisonous closes are used the breathing at once 
becomes rapid and then impaired and labored. Large doses produce 
death by paralysis of the respiratory centre. The causes of these 
changes are, primarily, the alterations in the blood which so influence 
oxygenation of the tissues as to lead the respiratory centres to greater 
effort, while at the same time they are beginning to be directly 
•depressed by the drug itself, so that impairment of their function 
soon asserts itself. Bokai asserts that the drug paralyzes the periph- 
eral motor nerves, which, if true, brings forward a third factor in 
the respiratory failure. 

Temperature. — Acetanilide, when given in full medicinal doses, 
lowers normal bodily temperature or else fails to produce any change. 
In poisonous doses it produces a decrease in temperature depending 
on the amount employed, and may produce collapse and rigors. On 
a fevered temperature it acts as a powerful and fairly constant anti- 
pyretic, lowering the fever by decreasing heat-production and in- 
creasing heat-dissipation, the production being the function most 
affected. 1 Whether the decrease in heat-production is due to an 
action on the heat-centres of the nervous system or upon other causes 
is not positively known. Some investigators have claimed that the 
fall depends upon the partial reduction of the haemoglobin of the 
blood whereby less oxygen is carried to the tissues and less combus- 
tion ensues. This seems doubtful in view of the fact that the most 
careful spectroscopic examination of the blood fails to show any such 
change. That the fall of temperature is not dependent on the sweat 
produced is proved by the fact that the temperature falls even if 
enough atropine be given to stop all perspiration. 

Kidneys, Tissue-waste, and Urine. — Much contradictory 
evidence exists in regard to the changes in these organs and excretory 
products, but most observers agree that the excretion of urea is 
increased, and it is also true that the more laborious researches reach 
this result. (Lepine, Chittenden and Taylor.) Less uncertainty 
exists as to its influence on uric acid, which is increased rather 
than diminished by the drug. After excessively large doses the 
urine becomes dark from the presence of broken-down blood. 

Elimination. — The drug is eliminated by the kidneys in the form 
of para-amido-phenol-sulphate. 

1 The conclusions of Evans and of myself have been severely criticised by H. C. 
Wood, but my reasons for holding to the opinions stated can be found in my essay on 
Antipyretics, Philadelphia, 1890. 



32 DRUGS. 

Antiseptic Action. — The drug possesses some slight antiseptic 
powers, but they are only asserted when the amount present is quite 
large. 

Toxic Changes from Prolonged Use. — Although it has been 
claimed that no untoward effects result from the prolonged use of 
antifebrin in large doses, there cau be no doubt that this is un- 
true. Under these circumstances congestions of the liver, kidneys, 
and spleen occur, and if the doses be poisonous clots fill the cardiac 
cavities. 

There may be also a progressive decrease in the number of the red 
blood -corpuscles. 

Poisoning. — In man the lips become blue, the face livid, cyanosed, 
and expressionless or anxious. The forehead and cheeks are covered 
by beads of sweat which gradually cover the rest of the body. The 
pulse is soft and compressible, but slow and finally very weak. The 
respirations are slow and shallow. 

The treatment should consist in supporting measures, the use of 
stimulants, external heat, belladonna to maintain blood pressure, 
strychnine to aid the respiration and oxygen inhalations if they are 
necessary to overcome cyanosis. 

Therapeutics. — The employment of the drug acetanilide in fevers 
must depend very much upon the exact condition of the patient and 
the form of his disease. As has already been pointed out, the mere 
presence of a malady, or of a high temperature, cannot, correctly 
speaking, be an indication for any particular remedy. The phase of 
the disease must be recognized and the question as to whether the 
fever which is present is harmful, must be duly weighed. 

In typhoid fever the studies of most clinicians show that though 
the drug possesses very decided antipyretic power, it often causes 
great depression and collapse, and in no way influences the duration 
or general course of the disease. 

For the same reasons the value of acetanilide in phthisis is doubtful, 
since, although it greatly affects the temperature, it is very apt to 
cause collapse, profuse sweating, and depression. Thus the writer 
has seen cases of phthisis where the attempt to control the fever 
resulted in the manner named, and Riese points out, what the author 
also noted, namely, that in this disease cyanosis is very apt to come 
on after the use of the drug. 

In regard to the employment of acetanilide in sthenic fevers, it at 
once becomes evident to the most careless student of medicine, that a 
drug absolutely unsuited to a case of asthenic disease may, on the 
other hand, agree with a scarlet fever patient very well. In conse- 
quence of this, we find that the sweating of acetanilide is not so 
marked or troublesome in diseases of a dynamic type, and that, in 
consequence, it more rarely causes collapse. 

In much the same manner as antipyrine was found, some time 
after its introduction, to be possessed of pain- relieving power, so 



ACETATE OF POTASH. 33 

acetanilide has also been discovered to possess similar properties, a 
discovery the credit of which must be given to the French investi- 
gator Lepiue, who has written upon this subject, at various times, 
very extensively. Almost every form of nerve pain seems to indi- 
cate its employment, and it has been successfully used in the crises 
of ataxia, the agonizing dartings of gastralgia, and even in chorea, 
with good results. In a corresponding manner Secretan has ob- 
tained brilliant effects in cases of sciatica, and Silva has seen the most 
obstinate headache yield to its influence. A large amount of expe- 
rience has proved it of value in epilepsy. 

The employment of acetanilide in rheumatism may be separated, 
if desired, into that devoted to the cure of the disease with the relief 
of pain, and the reduction of pyrexia. There can be no doubt what- 
ever of the ability of the drug to control the fever of this disease, 
and the question as to whether it favorably influences the progress 
of the malady is to be anwered very forcibly in the affirmative (see 
Rheumatism). 

Acetanilide has even been recommended as an haemostatic in epi- 
staxis and hcemoptysis. The dose for cases of rheumatism should be 
4 to 6 grains three times a day. 

Untoward Effects are not very common if acetanilide be used with 
care. The writer has collected a number of cases (38) in which 
unfavorable signs appeared after its use, but untoward action was 
never seen unless the dose given was excessive for the case in hand. 
The dose most commonly producing such symptoms was from 3 to 
10 grains. In only three instances did death occur, one from heart- 
clot and two from excessive dosage. No deaths are reported from 
moderate amounts, although some of the cases were very alarming. 

Administration. — Acetanilide may be given in doses varying from 
2 to 10 grains, the last-named amount being usually far too much. 
As it is virtually insoluble in water, it should always be administered 
in wine or spirit, in which it will dissolve, or in capsules or pills. 
Where neuralgias are to be treated, or similar forms of pain are 
preseut, mono-bromated camphor, in the dose of -J- a grain, may be 
combined with acetanilide with advantage. 



ACETATE OF POTASH. 

Potassii Acetas, U. S. and B. P., is a neutral white salt of saline 
taste, readily deliquescent and soluble in water. It was at one time 
very largely used in the treatment of rheumatism in the " alkaline 
method," but has been supplanted by the salicylates. If used, 1 
ounce to 2 ounces a day must be taken. A combination of 10 
grains of the iodide and 30 of the acetate are useful in rheumatism 
in some instances. 



34 DRUGS. 

In hepatic torpor acetate of potash is exceedingly useful, and aids 
in promoting the flow of bile. It has been used in the uric acid 
diathesis, and is supposed to purify the blood by aiding in the oxida- 
tion of effete material. The dose of potassii acetas is from 20 grains 
to 2 ounces. 



ACETATE OF ZINC. 

Zinci Acetas, U. S. and B. P., occurs in the form of white mica- 
ceous crystals, which are efflorescent and quite soluble in water. It 
acts as a decided astringent to the skin and mucous membranes, but 
is less astringent than the sulphate of zinc. It is used as a collyria 
in eye diseases, such as conjunctivitis, in the strength of 1 to 2 grains 
to the ounce. In gonorrhoea it is often employed instead of the 
acetate of lead in injections in the strength of 1 to 20 grains to the 
ounce of rose-water. 

The treatment of poisoning by acetate of zinc is that of gastro- 
enteritis. 



ACETIC ACID. 

Acidum Aceticum, U. S. and B. P., as used in medicine, is a clear 
liquid made up of 36 per ceut. of acetic acid and 64 per cent, of 
water, and has a sweetish odor. It- is obtained from wood by 
destructive distillation. 

Therapeutics. — Acetic acid is seldom used internally, except in 
combination with potash or soda. As an escharotic the glacial or 
absolute acetic acid {Acidum Aceticum Glaciate, U. S. and B. P.) is 
used, and is a powerful caustic, It can be applied to warts and 
other growths, and to old sores where the granulations are profuse 
and slow to heal. The dilute acid (Acidum Aceticum Dilutum, 
ZJ. 8. and B. P.) is used as a lotion in night-sweats, and to arrest 
epistaxis and other small haemorrhages. As a lotion to be widely 
employed it should be diluted one-half. Vinegar or acetic acid 
(Acidum Aceticum, U. S. and B. P.) has been used for the decrease 
of obesity, but it is a harmful and often useless remedy, disordering 
digestion and reducing the patient's strength. 

Poisoning. — Where over-doses of acetic acid are taken, the antidote 
consists in large doses of milk, alkaline liquids, such as lime-water, 
soap-water, etc., and the general measures adopted for the treatment 
of gastro-enteritis. 



35 



ACONITE, OR MONKSHOOD. 

The Aconite of the U. S. P. is derived entirely from the tuberous 
root of Aconitum Napellus. At one time the leaves were officinal, 
but are so no longer, and for this reason the term aconitum radix is 
not to be employed, as it is a useless distinction. 

The plant is indigenous in Germany, France, and Switzerland, 
and is cultivated as a garden plant all over Europe and America. 
The root is so strikingly like that of horseradish as to be readily 
confused with that article of food, but does not emit the pungent 
fumes of the latter when it is scraped or broken. It is to be re- 
membered, however, that it produces a distinct feeling of heat in 
the mouth when chewed. The active principle upon which its 
therapeutical value would appear to depend is aconitin, but there is 
reasonable doubt whether this can be relied upon as completely as 
the fluid preparations of the crude drug. 

Physiological Action : 

Nervous System. — Aconite in medicinal dose depresses the func- 
tional activity of the perceptive centres in the brain, the sensory 
side of the spinal cord, and, finally, the peripheral ends of the sen- 
sory nerves. Applied to a mucous membrane, it acts as a local 
anaesthetic, but is too irritating for use in the eye. On the motor 
portion of the body it possesses little effect, unless given in poison- 
ous doses, when it paralyzes the motor tract of the spinal cord and 
the peripheral motor nerves. 

Circulatory System. — On the heart aconite acts in moderate 
amount as a quieter of its movements and force, and so lowers blood- 
pressure and pulse-rate by a direct action on the heart muscle. There 
is no evidence of its possessing any direct influence on the vaso-motor 
system. In poisonous dose it causes first a very marked fall in 
pulse-rate, preceded sometimes by a rise in rate due to a condition ot 
weakness and abortive cardiac action, which finally gradually de- 
creases into diastolic arrest of the viscus, which is paralyzed and 
refuses to respond to stimuli. 

Respiration. — In moderate doses it quiets the respiratory move- 
ments slightly, particularly if the breathing is hurried before its use. 
In poisonous doses it paralyzes the respiratory centres, and so causes 
death. 

Temperature. — It acts as a distinct reducer of fever, probably 
because of increased heat-radiation due to relaxation of the capillaries 
and the impaired circulation. 

Kidneys. — Aconite in fever usually increases the urinary flow. 

Poisoning. — When aconite is taken internally in excessive amount 
it causes tingling of the mucous membranes wherever it touches 
them, which sensation finally amounts to severe burning. This soon 



36 DRUGS. 

passes away, and is followed by a sense of tingling about the lips and 
finger-tips, or all over the skin. At the same time the patient feels 
relaxed, the pulse becomes slow and weaker, but later on rapid and 
running so that it seems a mere trickle under the finger, sweating 
more or less severe asserts itself, and fainting may come on. Vomit- 
ing may be present, but rarely occurs. The respirations now become 
slow and shallow, seeming scarcely to expand the lung. The face is 
pallid and auxious. The eyes may show exophthalmos, or be sunken 
and dull. The pallor is excessive. Epileptiform convulsions may 
be present, due to disorder of the circulation at the base of the brain. 
Previous to this there may be marked anaesthesia of the skin. The 
pupils may be normal or dilated to a wide degree. The sclerotic 
coat of the eye is pale and pearly-looking. The temperature is very 
low. Death may be gradual or sudden, the slightest movement of 
the body which can throw any strain on the heart stopping that 
organ in diastole. 

Treatment of Poisoning. — The patient is to be placed in a 
prone position or on a board, with the feet higher than the head, to 
confine the circulation as far as possible to the base of the brain. 
Hot bottles or bricks are to be placed about the body for the purpose 
of maintaining the bodily heat. Emetics are not to be given if the 
symptoms are severe, as vomiting may cause cardiac arrest, owing to 
the muscular effort involved, or the stomach may be so depressed that 
the emetics will not act. If vomiting comes on let it be into a towel 
without the patient being allowed to raise the head. The stomach is 
to be washed out by means of a stomach-pump or a siphon made of 
rubber tubing. Ether may be given hypodermically and followed 
by alcohol, and this again by digitalis. The ether acts at once and 
lasts while the alcohol is being absorbed, and the alcohol supports 
the heart until the digitalis, which is the physiological antagonist of 
aconite, but slow and prolonged in its effects, asserts itself. If the 
breathing fails artificial respiration is to be employed, or if the heart 
seems about to cease its action a whiff of the nitrite of amyl may 
start it going again, but only a few drops should be used, as large 
amounts depress this organ. 

Preparations. — Tincture of aconite ( Tinctura Aconiti, U. S. and 
B. P.) is used in the dose of 1 to 5 drops in water, and repeated 
as needed. The extract of aconite (Extractum Aconiti, U. 8.) is 
given in the dose of one-quarter to three-quarters of a grain, while 
of the abstract ( Abstraction Aconiti, U. S.) 1 grain is used. The 
fluid extract {Extractum Aconiti Fluidum, U. 8.) is given in the 
dose of 1 to 2 minims. Fleming's tincture ought never to be used. 
The active principle aconitin is not officinal. Its dose is y^- 
of a grain. The B. P. preparations that are not officinal in the 
U. S. P. are aconite root [Aconiti Radix), aconite leaves (Aconiti 
Folia), aconitiu (Aconitina), aconite ointment ■( Unguentum Aconitice), 
and aconite liniment (Linirnentum Aconiti). The dose of the extract 



AGARICIN. 37 

of aconite [Extractum Aconiti, B. P.), is 1 to 2 grains, and that of 
aconitina jfo of a grain. 

Therapeutics. — The employment of aconite is disease is one of the 
most universally recognized procedures in medicine. It fulfils indi- 
cations which nothing else can fulfil, and lends itself to the manage- 
ment of a large number of morbid processess, in all of which its 
effects are explainable by its known physiological action. It is used 
chiefly for its influence as a cardiac and circulatory quieter, for its 
effects on the peripheral sensory nervous system, as in the vomiting 
of pregnancy, and in those states in which, through inflammation else- 
where, the nervous system needs a sedative which will at the same 
time reduce arterial tension. It may be applied locally over super- 
ficial nerves in neuralgia in the form of an ointment (2 grains to 1 
drachm, or as the oleate of aconitine, 2 grains of the oleate to 100 of 
sweet oil). It is useful in croup, quinsy, sore-throat, severe colds, 
bronchitis, and asthma due to exposure, in their early stages. In peri- 
carditis it is valuable to allay the inflammation and quiet the excited 
heart. In adynamic, asthenic affections it ought not to be used. 
Aconite is useless and harmful iu prolonged acute diseases such as 
scarlet fever, if constantly employed. 

In nervous palpitation of the heart and in the palpitation of excessive 
cardiac hypertrophy it is very valuable. In the epistaxis of full- 
blooded people, and in the early stages of gonorrhoea and chordee it 
ofteu affords great relief. Aconite is by far the best circulatory and 
nervous depressant for children suffering from sthenic fever, par- 
ticularly of the irritative type. 

Administration. — As a general rule, small divided doses of the 
drug in the form of the tincture (Tinctura Aconiti) \ to \ drop 
given every fifteen miuutes, will act better than a full dose given at 
once. 



AGARIOIN. 

Agaric, or touchwood, or punk, has been used in the southern 
United States very largely in the dose of five grains every few hours 
in the night-sweats of phthisis, and agaricin, the alcoholic extract of 
the drug, has been used with very extraordinary results, under these 
circumstances, by certain German and English physicians in the dose 
of from 1 to 2 grains every five hours. Its physiological action 
is unknown, but it is supposed to act upon the nerve filaments in the 
sweat-glands. The writer has employed it frequently in varying 
dose, and has never seen any decrease in the sweats of phthisis 
produced by it whatever, although he has watched it most closely, 
expecting to see patients obtain great relief therefrom. 



38 DRUGS. 



ALCOHOL. 



Ethyl alcohol {Alcohol Ethylicum, B. P.) is the only alcohol used 
in medicine. Some of the other alcohols are exceedingly poisonous. 
A my lie alcohol is fusel oil. 

Alcohol is a liquid derived from the fermentation of starches or 
sugars in the presence of heat. It is officinal in two forms, namely, 
as Alcohol, U. S., containing 91 per cent, of the spirit and M per cent, 
water, and Alcohol Dilutum, U. S., or dilute alcohol, 45.5 per cent, 
spirit and the remainder water. The drug is generally given in 
the form of whiskey or brandy, and when the word alcohol is used 
in the saying, " Give the patient alcohol," one of these two liquids is 
always meant unless it is otherwise stated. 

Physiological Action. — Upon the nervous system alcohol acts first 
as a powerful excitant and afterward as a most active depressant and 
paralyzant. Locally applied in small amounts to the peripheral 
nerves it excites them at first and paralyzes them afterward. By the 
primary stimulation of the brain it increases the rapidity, but not the 
depth of thought, while it increases the reflex activity of the spinal 
cord, muscles, and nerves. In large dose it produces lack of coordi- 
nation by depression of the brain and lower nervous system, the loss 
of coordination being due largely to sensory paralysis so that the 
power of touch is interfered with- This causes a drunken man to 
fail to realize the surfaces of obstructions, and the impaired mental 
power and disordered judgment, combined with badly acting motor 
and sensory pathways, cause him to stumble and fall. 

Circulatory System. — When alcohol is given to man or animals 
it stimulates the heart muscle and increases its rate of beating as 
well as its force. According to Dogiel, the increase in rate is due 
partly to stimulation of the accelerator nerves, while Castillo denies 
any such influence. Wood teaches that the action is not on these 
nerves, and is undoubtedly correct in his belief. Along with the 
stimulation of the heart a rise of arterial pressure ensues, largely due 
to increased heart action and partly to vaso-motor stimulation. In 
very large toxic doses alcohol depresses and finally paralyzes the 
heart and vaso-motor system as well as the nervous system. 

Respiration. — Bespiration is stimulated by small doses and 
decreased by large ones. 

Temperature. — Alcohol at no time increases to any extent the 
actual number of heat units in the body. It produces a sensation of 
warmth and warms the extremities by causing the heart to pump hot 
blood from the centre of the body to the cold parts. If it is used in 
excess the temperature rapidly falls, owing primarily to the increase 
of heat radiation produced by the excessive distribution of heat just 
named, and secondarily by the depression of vital power which is 



ALCOHOL. 39 

produced. Calori metrical studies show that while more heat may be 
made under its influence so much heat is dissipated that the tempera- 
ture nevertheless falls. 

Bodily Metabolism. — The quantity of carbonic acid given off by 
the body is increased under the use of alcohol in most instances; but 
it may be decreased. The effect on the absorption of oxygen is not 
known. Some observers have noted an increase, some a decrease, 
and some no change at all, when alcohol is taken. Upon the giving 
off of nitrogenous substances it acts as a decided depressant, which 
seems to prove that it inhibits rapid tissue changes, and is a conser- 
vator of vital power. It adds force to the body, but not tissue. 

Elimination. — Alcohol is most of it burnt up in the body, but 
when taken in excess of this oxidizing power it is eliminated by the 
breath, the skin, kidneys, and intestines. 

Digestion. — Alcohol added in any amount to food in a test-tube 
containing digestive fluids prevents and inhibits digestion, but in the 
stomach aids digestion very much, by reason of its irritant and stim- 
ulating properties, which cause an excess of digestive juice to be 
secreted. 

Therapeutics. — The employment of alcohol in disease can now be 
only briefly alluded to, special mention of its indications being named 
where the diseases in which it is used are discussed. Its chief use 
is as a rapidly acting stimulant in all forms of cardiac failure due 
to shocks or poisons, and as a systemic support and stimulant in low 
fevers and in prolonged wasting diseases, or in old age and convales- 
cence from acute disease. 

Some of the conditions, to state them specifically, in which alcohol 
is indicated are sudden fainting, snake-bite, surgical shock, acute, 
subacute and chronic pneumonia in its later stages, in typhoid fevers, 
and in excessive wasting, due to prolonged suppuration. In phthisis, 
in neuralgia, and similar states dependent upon depression of the 
system, care must be taken to prevent the setting up of a " habit." 
It is very useful as a local application to ulcers and wounds, as an 
antiseptic and stimulant, or when combined with salt in cases of 
debility and atony of the skin and subcutaneous tissues. 

Acute Poisoning. — In advanced poisoning, with coma and total re- 
laxation, external heat and hypodermic injections of digitalis are indi- 
cated if the heart seems failing. Belladonna should be administered 
to stimulate the vaso-motor system if the skin is relaxed and clammy, 
and counter-irritation to the back of the neck is to be employed if 
any brain symptoms seem pressing. The after-treatment consists in 
the use of substances stimulating to the stomach, such as ammonia, 
spirits of Mindererus and spices, unless there is gastric inflammation, 
when emollient substances should be used to quiet the irritation. If 
persistent vomiting comes on it must be quieted by pieces of ice, 
aconite, cocaine, or minute doses of ipecac, with counter-irritation over 
the belly. If the emunctories are not acting freely a thorough purga- 



40 DRUGS. 

tion by jalap or elaterium (40 grains of jalap powder or 1 grain of 
elateriurn) should be employed, or calomel followed by a saline may 
be given if slighter effects are needed. In view of the frequency 
with which alcoholic and opium poisoning are confused, the follow- 
ing table is appended, which is of value in making a differential 
diagnosis as to the condition of the patient : 

Alcoholism and Opium Poisoning. 

Alcoholism. Opium Poisoning. 

1. Pupils normal or dilated. 1. Pupils contracted. 

2. Respiration nearly normal, pulse 2. The respiration and pulse are slow 
rapid, and finally feeble. and full. 

3. Face may be pallid. 3. Face more suffused and cyanosed. 

4. Skin cool, perhaps moist, scarcely 4. Skin warmer than in alcoholic 
any difference in consciousness. poisoning. 

5. Urine is always to be saved for 
medico-legal examination. 

Acute Alcoholism and Apoplexy. 

Alcoholism. Apoplexy. 

1. Pulse is rapid, comjDressible, and 1. Pulse apt to be strong, slow. 
weak. 

2. Skin moist, or relaxed and cool. 2. Skin hot or dry. 

3. Bodily temperature lower. 3. Bodily temperature raised. 

4. Pupils equally contracted or dilated, 4. Pupils unequal, 
generally dilated. 

5. No hemiplegia. 5. Hemiplegia; one side tossed, the 

other remaining motionless. 

6. Breathing not so stertorous, nor so 6. Respiration stertorous: the lips being 
one-sided in lips. inflated on one side on expiration. 

7. ISTo facial palsy. 7. Facial palsy. 

8. Unconsciousness may not be com- 8. Unconsciousness complete, 
plete. 

The smell of alcohol on breath is no guide, as an acute excess of alcohol may have 
caused the rupture of a bloodvessel. 

Chronic Poisoning. — The treatment of this condition may be car- 
ried out in two ways : First, by the isolation of the patient and the 
complete withdrawal of the drug at once, or, second, what is better, 
a gradual tapering-off in the daily amount of spirit. In either 
instance isolation must be absolute, and all smuggling of alcohol 
to or by the patient prevented. The attendants must be absolutely 
trustworthy, and careful scrutiny of the bed-clothes and closets will 
often be rewarded by finding hidden bottles. The depression must 
be treated by the use of nutritious broths highly seasoned, in order 
to stimulate the stomach, easily digested or predigested foods, and 
small doses of morphine or coca if the patient is very weak and 
needs stimulus. Koumyss is an exceedingly valuable preparation 
under these circumstances. In the treatment of the atonic stomach 
of drunkards nothing does so well as the following pill : 



ALCOHOL. 41 

]£. — Gleoresin. capsici TTt x - 

Olei caryophylli . . . . ... . • • . TTL x. 

Hydrarg. chlor. mit. . . gr. xx. 

Aloes Socotrin. . . . . . . . . . . gr. xl. 

M. — Ft. in pil. Xo. xx. S. One three times a day after or before meals. 

(See article on Capsicum.) 

Chronic alcoholism may produce cirrhosis of the liver with the 
resulting symptoms, notably ascites. 



Differential Diagnosis of Alcohol ism and General Paralysis 
of the Insane. 

Alcoholism. Paretic Dementia. 

1. The attacks are shorter, and are more 1. Attacks are prolonged, 
widely separated by intervals of sanity. 

2. The delirium may be of any char- 2. Delirium of grandeur is more marked 
acter. and defined. 

3. The visions are more characteristic, 3. The visions are often not evil, but 
and are evil. pleasant. 

4. The tremors are confined to the head 4. Tremors are more diffused, 
and arms. 

5. Tremors are removed by dose of alco- 5. Tremors are made worse bv alcohol, 
hoi. 

6. Mental symptoms temporarily re- 6. Mental state made worse by alcohol. 
moved, or, at any rate, improved, by 

alcohol. 

7. Tremors occur chiefly in the morn- 7. Tremors not confined to the morn- 
ing, ing. 

There is clanger of pneumonia from failure of right side of heart 
in chronic alcoholism, and this state should always be sought for. 

Administration. — Brandy and whiskey are generally used as 
rapidly acting stimulants. They should be given according to the 
work they are intended to perform. If the action must be instan- 
taneous, as in fainting, they must be employed hot and concentrated 
so' that the stomach will not have to warm the liquids before absorp- 
tion, or they are to be used hypodermically if a still more rapid 
action is required. If they are to aid digestion and support the 
system, then they should always be given with the food ; never alone, 
and never concentrated. They may be given as milk-punch or 
as egg-nog, the latter being the "heavier" of the two so far as 
digestion is concerned. AVine-whey is very light and useful. 

Mulled wine and champagne are particularly useful in irritable 
stomach. The latter should always be as devoid of sugar as possible, 
that is, w r hat is known as u extra dry." Gin is rarely employed as a 
stimulant, unless in young children or adults when the kidneys are 
torpid. Stout and porter are of value in wasting diseases, in conva- 
lescence from acute diseases, and for nursing women. Lager beer 
contains too little alcohol to be used as a distinct stimulant, but may 
be used in moderation to aid digestion, or ale may be employed instead. 



42 DRUGS. 

Clarets are useful as aids to digestion, and ports are also of value in 
these cases. 

Contra-indications. — All states of cerebral excitement, acute in- 
flammations, the alcoholic habit, apoplexy, meningitis, acute neph- 
ritis, aneurism and advanced atheroma contra-indicate the use of 
alcohol. 

The officinal preparations of alcohol are as follows : 

Whiskey (Spiritus Frumenti, U. S.) should be at least three years 
old, and be made, in America, from rye for medicinal purposes. 

Brandy (Spiritus Vini Gallici, U. S. and B. P.) is obtained by 
the distillation of fermented grapes or fruits, and should be from 
three to five years old before use. 

Cologne Water (Spiritus Odoratus, U. S.) is used solely as a 
lotion and perfume 

Red W 7 ine ( Vinum Rubrum, U. 8.) is made from grapes not de- 
prived of their skins. White Wine (Vinum Album, U. S.) is the 
fermented juice of the grape without the skins being present during 
the process. 

Dilute (Alcohol Dilutum, U. S.), and pure alcohol (Alcohol, U. S.) 9 
are also officinal. 

The unofficial preparations are : 

Rum, which is made from the fermentation of molasses, and con- 
tains about 40 to 45 per cent, of alcohol. 

Gin is made from rye or barley and has added to it juniper berries 
and hops. (Good gin and the Spiritus Juniperi Compositus of the 
U. S. Pharmacopoeia are virtually identical therapeutically). Where 
diuresis is required and atony of the kidneys is present without in- 
flammation, gin is a useful medicament if stimulants are also needed. 
It is one of the alcoholic drinks most apt to produce cirrhosis of the 
liver. 

Port Wine ( Vinum Portense, U. S. and B. P.) is a fermented 
wine to which pure spirit is added to increase its strength. It is 
one of the strongest table wines, and is useful as a stimulant in 
convalescence. 

Sherry ( Vinum Xericum, B. P.) has about 30 per cent, of alcohol 
in it. It is not officinal in the U. S. P. 

Beer is made by a slow fermentation, while ale is made by a more 
rapid fermentation at a higher heat. 

Porter resembles the other malt liquors closely, except that it con- 
tains more solids, due to the scorching of the grain by a high heat. 

The B. P. preparations that are not officinal in the U. 8. P. are 
rectified spirit (Spiritus Rectificatus), proof spirit (Spiritus Tenuior), 
sherry (Vinum Xericum), amylic alcohol (Alcohol Amylicum), and 
Mistura Spiritus Vini Gallici. 



ALMONDS. 43 



ALLIUM. 



Garlic is a stimulant to digestion owing to the volatile oil contained 
in it, which, by its somewhat irritating qualities, excites the gastric 
mucous membrane to increased secretion. In persistent colds, where 
the bronchial tubes are particularly affected, a garlic poultice made 
by pounding the bulbs in a mortar is a very efficient, though dis- 
agreeable, remedy. In the case of children with colds, garlic may 
be used boiled in milk and allowed to cool, or the oil of garlic may 
be given in emulsion in the dose of 1 to 2 drops. If the skin is too 
delicate in any case to permit of the use of pounded garlic alone, it 
may be mixed with equal parts of bran, and a regular poultice or 
plaster made thereby. Employed in this way allium is useful over 
the spine in spinal convulsions of infants, and, when put over the 
belly, it acts almost as well as a spice poultice in cases of gastro- 
intestinal catarrh. The dose of the syrup (Syrupus Alii, U. S.) is 



1 to 4 drachms. 



ALMONDS. 



Almonds are officinal in the form of the bitter almonds (Amyg- 
dala Ama.ra, TJ. S. and B. P.) and the sweet almonds (Amygdala 
Dulcis, TJ. S. and B. P.). The bitter almonds when in the presence 
of water develop hydrocyanic acid by the combination of the amyg- 
dalin and emulsin contained in them, but the sweet almonds do not 
do so. 

Sweet almonds when rubbed up with water form a pleasant-tasting 
emulsion of an agreeable odor, very useful as a vehicle for other 
remedies of a disagreeable taste. Almond bread has been proposed 
as a food for diabetics, owing to its containing virtually no starch, 
but it is necessary that the oils and saccharine constituents of the 
almond should first be removed. 

When half an ounce of sweet almonds are rubbed up in a mortar 
with thirty grains of gum arabic and two drachms of sugar, to which 
are added gradually a half pint of distilled water and the mixture 
strained, an emollient and soothing drink is made, very useful in 
irritations of the stomach and intestines, and of the air-passages and 
pharynx. The expressed or essential oil of almonds is a useful 
demulcent, and has been recommended in the cough of phthisis given 
in the dose of a few drops in emulsion. 

Bitter almonds give off an oil (Oleum Amygdcdce Amarce, TJ. S.) 
which is exceedingly poisonous owing to the prussic acid which it 
contains, and it is said that one drop will kill a cat, while seventeen 
drops have killed a man. 

Bitter almonds are used to allay irritable coughs and similar 



44 DRUGS. 

states, but are riot frequently employed, because other drugs are less 
dangerous, more stable, and more active as remedial agents. The 
emulsion of bitter almonds is made as is that of sweet almonds, and 
may be used in teaspoonful doses for the purposes named when sweet 
almonds were considered, and as a vehicle in cough mixtures. Both 
emulsions are useful as vehicles in gonorrhoea to diminish the burn- 
ing on urination, and are supposed to be of value for the removal of 
freckles and sunburn when locally applied. 

The preparations of sweet almonds are — a mixture (Mistura Amyg- 
dake, TJ. 8. and B. P.), dose 1 to 2 ounces ; a syrup (Syrupus Amyg- 
dake, TJ. S.), dose 2 drachms to 2 ounces; a compound powder (Pulvis 
Amygdake Compositus, B. P.), given in the dose of 1 to 2 drachms ; 
and the oil {Oleum Amygdake Expressum, TJ. S. and B. P.), the dose 
of which is 1 to 4 drachms. Aqua Amygdake Amarce (B. P.) is 
prepared from the oil of bitter almonds. 



ALLSPICE. 

Allspice or Pimento, TJ. S. and B. P., is the nearly ripe fruit of 
Eugenia Pimento., a tree of the West Indies. It contains an officinal 
volatile oil (Oleum Pimentce, TJ. S. and B. P.), and is used for 
flavoring purposes, as a constituent of spice plasters, in diarrhoea 
mixtures, or as a carminative. It will also prevent the griping of 
purgative medicines. The dose of the oil is one to five drops. Aqua 
Pimentce, B. P., is given in the dose of'l to 2 ounces. 



ALOES. 

Aloes or Aloe ( TJ. S.) of the T\ 8. P. is derived solely from the 
Aloe Socotrina, while that of the B. P. is obtained not only from 
Socotrine aloes, but also from Barbadoes aloes (Aloe Barbadensis, 
B. P.). It is the inspissated or dried juice of the leaves of the plant, 
but the actual species from which the drug is derived is uncertain, 
probably from several species. It contains an active principle known 
as aloin, which is a crystalline substance. As aloin is generally sold, 
it is, however, an amorphous powder of extremely bitter taste. 

Physiological Action. — Locally applied to the tongue, aloes is a 
bitter of rather a persistent taste. According to the studies of 
Rutherford, the drug increases very considerably the flow of bile in 
the dog, but in man it cannot in any sense be regarded as a remedy 
for the production of an increased biliary flow. Rutherford's doses 
amounted to as much as sixty grains to the dog, which are equal to 



ALOES. 45 

three or four drachms in man. In the lower animals and man it 
acts very slowly, requiring many hours for its influence to be dis- 
tinctly felt, unless the dose be toxic in amount. As much as four 
drachms of aloes have been injected into the veins of a horse without 
inducing purgation, probably because four drachms were not enough 
to affect the bowels. It has been used endermically, and when so 
employed is said to act thoroughly. It is eliminated by the milk of 
nursing women, and will cause purgation in an infant put to the 
breast of such a patient. If the doses be quite large (10 to 20 
grains), the passages will be watery; but if the dose be more moderate 
(2 to 3 grains) the stools will be more thick and pultaceous. 

Therapeutics. — Aloes only should be used when a somewhat slow 
stimulant to peristaltic movement is desired, and never where the 
object of the physician is to relieve congestions by depletion through 
the intestine. It is a favorite remedy in cases of subacute or chronic 
constipation, but is distinctly harmful if continued constantly for any 
length of time, as it seems to produce atony of the bowel. Owing to 
its bitter properties it acts as a tonic to the stomach, and is often 
given with iron to favor the absorption of this metal by stimulating 
the liver and by preventing any constipation produced by the 
chalybeate. 

When taken in a large enough dose to produce a copious passage, 
it nearly always produces a feeling of weight and fulness in the 
region of the rectum after the evacuation, and the writer has seen 
severe rectal catarrh set up in this way. If given alone it is very 
apt to produce griping, and it ought always to be combined with 
some other drugs whose tendency it is to prevent intestinal spasm. 

In cases of hcemorrhoids occurring in persons suffering from gen- 
eral muscular relaxation and atony it is said to do great good, but 
its use under these circumstances is by no means universal or gener- 
ally accepted as correct. In weak, anaemic persons, leading sedative 
lives, it may be used combined with tonics to relieve the constipation 
so often a pressing symptom in these cases. In amenorrhosa depen- 
dent upon atony of the sexual system, or anaemia, or constipation, it 
is thought to have a specific emmenagogue influence. Locally ap- 
plied in the form of the glycerole of aloes, it has been employed in the 
healing of old and new fissures of mucous membranes, and even in 
bedsores. The glycerole of aloes is to be made by evaporating four 
to eight quarts of tincture of aloes and gradually adding thirty parts 
of glycerine. 

Contra-indications. — Constipation occurring in plethoric persons 
should not be treated by aloes, and it should not be used if any irri- 
tation or catarrh of the intestine is present. 

Administration. — Aloes is generally given in a pill, combined 
with spices and belladonna (see Constipation). The dose should 
be about 1 to 5 grains as a laxative, and 10 grains as a purge. 
The Aloe Purificata, U. S., should always be used. The officinal 



46 DRUGS. 

preparations most commonly employed are the pill of aloes (Pilulce 
Aloes, V. S. and B. P.), two grains aloes and soap each ; the pill of 
aloes and myrrh (Pilulce Aloes et Myrrhce, 77. 8. and B. P.), two 
grains of each constituent ; the pill of aloes and mastisch (Pilulce 
Aloes et Mastiches, 77. 8., two grains of aloes), or the "Lady Webster 
dinner pill;" the pill of aloes and iron (Pilulce Aloes et Ferri, 77. 8. 
and B. P.), one grain of aloes and one of dried sulphate of iron, and 
the pill of aloes and asafoetida (Pilulce Aloes et Asafcetidce, 77. 8. and 
B. P.), four grains of aloes, asafoetida, and soap. The liquid prepa- 
rations are the tincture ( Tinctura Aloes, 77. 8. and B. P.), dose 1 to 3 
fluidrachms; the tincture of aloes and myrrh (Tinctura Aloes et 
Myrrhce, U. 8.), dose 1 to 2 fluidrachms ; x and the wine of aloes 
( Vinum Aloes, 77. 8. and B. P.), containing cardamoms and ginger, 
the dose of which is J to 1 drachm, or even 2 drachms. The B. P. 
preparations, besides those given, are Aloin, dose J to 2 grains ; 
Enema Aloes, given in the dose of 1 ounces ; the Decoetum Aloes 
Compositum, dose, J to 2 ounces ; and the extract, Extractum Aloes 
Socotrince and the Extractum Aloes Barbadensis, the dose of each of 
which is 2 to 6 grains. 



ALUM. 

Alum (Alumen, 77. S. and B. P.) is the sulphate of aluminium and 
potassium, or of aluminium and ammonium, crystallized from a 
watery solution. At present all the alum of commerce is made in 
the manufacture of coal gas for illuminating purposes, and it is 
therefore very cheap. It occurs in the form of octahedral crystals, 
and has an astringent taste and acid reaction. After the crystals 
are exposed to the air for some time they become covered with a 
white coating. 

Physiological Action. — When alum is brought in contact with a 
mucous membrane it produces whitening, constriction, and pucker- 
ing ol the part, and applied to the skin thickens and toughens it by 
means of its astringent action. In either case it decreases secretion 
and causes contraction of the local bloodvessels and capillaries. 
Large amounts given for any time seem to increase secretion. Very 
large amounts are necessary to produce death. As much as two 
ounces will not kill a sickly dog. This is largely due to the fact 
that the vomiting and purging rids the animal of the drug, for if 
vomiting is prevented death rapidly ensues from gastro-enteritis. 
Injected into the blood it produces embolism and thrombosis. 

Therapeutics. — Alum is used at present in a number of diseases, 
chiefly as a local application. In case of ordinary sore-tkroat appli- 
cations of a strong solution (20 grains to the ounce of water) on a 

1 Sometimes called Elixir Proprietatis- 



ALUM. 47 

swab will be found very useful. It is a valuable gargle in this con- 
dition, but ought not to be used because of its destructive action on 
the teeth. In haemorrhage, where the leaking bloodvessels can be 
directly reached, alum is a remarkable haemostatic, aiding in the 
arrest of the bleeding in three ways, namely, by coagulating the 
albumin, by constringing the parts, and by crystallizing when ap- 
plied in large amounts on liut, and thereby affording a surface which 
is rough and aids coagulation. In haemorrhage after tooth-extraction 
this is a very useful treatment. Dissolved in water, or alcohol, it 
makes an exceedingly efficient application for sponging in night- 
sweats or localized sweating of the feet or hands. In conjunctivitis as 
a lotion alum may be employed in a solution of 1 to 3 grains to the 
ounce of water for a child, or in the form of alum curd, made by 
adding powdered alum to milk or white of egg until a curd is formed, 
which is then applied to the eye every few hours or oftener. This 
is often useful in ecchymosis of the eyelid, or " black eye," to prevent 
much exudation and discoloration. In cases where granular con- 
junctivitis occurs the use of the alum crystal or stick is sometimes 
very useful, the lid being lifted and the alum passed lightly over it. 
In haemoptysis a fine spray of a strong solution of alum, 20 grains to 
the ounce, may be employed, the necessity of the spray being very fine 
being constantly borne in mind. This method may also be resorted 
to in bronchorrhoea or chronic bronchitis with excessive secretion, and 
in chronic catarrh of the pharynx and larynx. In mercurial ptyalism 
the drug may be used on a swab. Bathing the parts affected with an 
alum solution is said to be an efficient remedy in chilblains and even 
in pruritus vulvce. As a vaginal wash for excessive leucorrho?,a in 
the strength of from 10 to 20 grains to the ounce of water it is of 
value. Some observers claim good results from its use in diphtheria 
and tonsillitis. In follicular tonsillitis the alum stick may be deeply 
applied to the swollen or depressed follicles. Burnt Alum (Alum 
Exdccatum, U. S. and B. P.) is useful as a dressing for old ulcers 
and sores, and has been highly recommended as an application for 
swollen gums where they press and over-ride a tooth, particularly at 
the back of the jaw. In ingrowing toe-nail with granulations, a piece 
of twisted absorbent cotton soaked in strong alum solution and in- 
serted under the edge of the nail, will do a great deal toward a cure 
in most instances. 

Internally alum has been used in diabetes, gastralgia and dysentery 
of an acute and chronic type. In lead colic it seems to be of value 
in conjunction with morphine to allay the pain. In some forms of 
constipation it is said to be quite valuable if given in large dose. At 
one time it was largely employed in membranous croup in emetic 
dose for the dislodging of the membrane and the astringent effect as 
it was swallowed and expelled. 

Alum may be used as an antidote in acute lead-poisoning, as it is 
a soluble sulphate and also an emetic. 



48 DRUGS. 

The emetic dose of powdered alum is a heaping teaspoonful to a 
child or a tablespoonful to an adult. 

Glycerinum Aluminis (1 to 5) is officinal in the B. P., and is 
used as a local astringent application. 



AMBER. 

Succinum is derived from a fossil resin found in Prussia and 
Bohemia and is officinal in the form of the oil (Oleum Succini, 
U. S.), which is volatile, quite irritant, and obtained by destructive 
distillation from the deposits named. 

Therapeutics. — Oil of Amber is one of the best remedies for per- 
sistent hiccough that we have. It is very useful as a counter-irritant 
over rheumatic joints, and has been used in asthma, whooping-cough, 
and hysteria with good results. In the bronchitis of infants, with 
nervous disturbance, oil of amber in the proportion of one to three 
parts of olive oil applied to the back and front of the chest is of 
service. The dose internally is 2 to 6 minims in emulsion. 



AMMONIA. 

Ammonia is a gas of a very acrid, burning taste and sensation, 
capable of producing death very rapidly, when inhaled, by the in- 
flammation and spasm of the glottis which ensues. It is made in 
large amounts in the manufacture of coal gas. 

Physiological Action. — When ammonia comes in contact with the 
tissues of the body it acts as a most powerful irritant, causing a red- 
dening of the parts, followed, if the exposure be long enough, by 
death and sloughing. If it be inhaled as a gas it may produce 
instant death by spasm or oedema of the glottis, or if a strong solu- 
tion of it is swallowed the same accident will occur. After more 
moderate inhalations severe bronchitis or pulmonary oedema may 
occur. 

Nervous System. — If ammonia be injected into the blood of 
animals violent convulsions at once ensue which are largely tetanic 
in type and depend upon a spinal action of the drug, since they are 
not stopped by division of the spinal cord, as they would be if the 
convulsive movements had their origin in the brain. The drug in 
moderate amounts acts as a spinal excitant, increasing reflex action 
and all the evidences of spinal activity. If applied directly to a 
nerve, either motor or sensory, it paralyzes it, or if it be in very weak 
solution it seems to increase its functional activity. 

Circulation. — Upon the circulation ammonia acts as a very power- 



AMMONIA. 49 

ful but fleeting stimulant, increasing to a very great extent the pulse- 
rate, pulse force, and arterial pressure. The cause of the increased 
pulse-rate depends upon stimulation of the accelerator nerves of the 
heart, and of the heart itself, while the increased force is due to the same 
cause, for Ringer and Saiusbury found the strength of the veutricles 
much increased. The rise of arterial pressure is due to the increased 
amount of blood pumped into the arteries by the stimulated heart 
aud probably by an action on the vaso-motor centre, although it is 
stated that this is not so. As the drug acts as a stimulant on the 
respiratory centre, which is very near the vaso-motor centre, it prob- 
ably increases the functional activity of both. If by means of intra- 
venous injection the ammonia reaches the heart in large amount, 
this organ ceases its beat at once from paralysis of its muscular walls. 

The Blood. — In moderate amounts the drug has no effect on the 
blood, but when injected in poisonous quantities it causes the blood 
to fail to take up oxygen, according to Feltz and Hitter. 

Respiration. — The injection of ammonia in moderate quantities 
into the blood causes an acceleration of the rate of respirations due 
to a stimulation of the respiratory centre, so that the respiratory 
movements not only become more full but more rapid. If the drug 
is inhaled in small amounts the same action is seen in a less degree 
and the changes both in breathing and circulation are partly due 
under such circumstances to a reflex irritation transmitted along the 
sensory nerves. 

Elimination. — Ammonia, when taken into the body, is so ex- 
tremely fleeting in its action, that the question as to its escape is one 
of interest. If large amounts are taken it is partly given off by the 
breath, but more of it is burnt up in the system, and, according to 
Bence Jones, eliminated as nitric acid by reason of its being oxidized 
in the body. Some persons think that it is partly excreted as urea. 

'Therapeutics. — Ammonia is employed for three distinct purposes 
in medicine, provided that its salts are not considered ; namely, as a 
circulatory and respiratory stimulant, as a counter-irritant, and as an 
antacid. 

The indications for its use in the first class of cases are all forms 
of sudden cardiac failure, where there is no time nor opportunity to 
use the more stable and slowly acting drugs. These instances occur 
in snake-poisoning, in syncope from fright or other shock, or indiges- 
tion, in sudden cardiac failure in fevers and pneumonia, and in all 
cases where rapid cardiac stimulation is needed. Ringer has found 
that the drug has the extraordinary power of causing a heart stopped 
or depressed by chloroform to return to its beating. In these press- 
ing cases it should be injected directly into the vein of the leg so as 
to act more quickly. If put into the subcutaneous tissues it is almost 
certain to make a slough, and if injected into a vein of the arm it 
may reach the heart in too concentrated form and cause cardiac de- 
pression. 

4 



50 DRUGS. 

Iii gastric acidity due to fermentation, with the development of 
abnormal acids, it is the most active remedy we can employ, but is 
not to be given if acute irritation of the stomach exists. 

In prolonged diseases its employment is not particularly advisable, 
owing to its fugacious action, although it is largely used, and the 
constant administration necessarily required is apt to produce gastric 
disorder. After surgical operations in children it seems to be ot 
value in the form of carbonate, two grains in mucilage of acacia 
and water every two hours. Some persons claim that ammonia is 
useful as a sedative in drunkenness, but this is doubtful. 

Locally applied, strong ammonia water may be used to produce a 
blister by placing a few drops on the skin under an inverted watch- 
glass. Ammonia water may also be applied to the spots stung by 
insects often with great relief. The waters of ammonia are used 
externally in stimulating liniments and hypodermically when the 
drug is so given. The stronger water ought not to be employed for 
the latter purpose. The aromatic spirit is generally used internally 
in the dose of J drachm to 1 drachm, well diluted. This is also the 
dose of the ordinary spirit. The carbonate of ammonium is given 
in the dose of from 5 to 15 grains, and the muriate in the same 
quantity. 

Administration. — Ammonia is never employed in medicine as pure 
ammonia, but in the form of the stronger water (Aqua Ammonice 
Fortior, U. S. ; Liquor Ammonia? Fortior, B. P) and the weaker water 
(Aqua Ammonice, U. S.; Liquor Ammonice, B. P.) ; the spirit of 
Mindererus (Liquor Ammonice Acetatis, U. S. and B. P.), dose 1 to 2 
fluidrachms ; the spirits of ammonia (Spiritus Ammonice, U. S.), dose 
30 to 60 minims in water; the aromatic spirit of ammonia (Spiritus 
Ammonice Aromaticus, U. S. and P. P.), dose 25 to 60 minims in 
water; sulphate (Ammonii Sulphas, U. S.), phosphate (Ammonii 
Phosphas, U. S. and B. P.), and valerianate of ammonium (Ammonii 
Valerianas, U. S.). The B. P. preparations besides those given 
are : Sulphide of Ammonium, Oxalate of Ammonium, Liquor Am- 
monii Citratis dose 2 to 6 fluidrachms, Liquor Ammonii Citratis 
Fortior dose 30 minims to 2 fluidrachms, Liquor Ammonii Acetatis 
Fortior dose 25 to 75 minims, Spiritus Ammonice Fcetidus, and Lini- 
mentum Ammonice, U. S. and B. P. 



Benzoate of Ammonium. 

Benzoate of Ammonium (Ammonii Benzoas, JJ. S. and B. P.) is 
employed chiefly for its diuretic influences, which depend entirely 
upon the benzoic acid present in the compound. As benzoic acid is 
eliminated as hippuric acid, and ammonia as nitric acid, this drug 
may be employed in cases where the physician desires to make the 
urine decidedly acid ; as, for example, in patients suffering from 



AMMONIUM. 51 

catarrh of the bladder when the urine is loaded with phosphates, 
which may be dissolved by this acidulation. The dose is 10 to 30 
grains. 

Bromide of Ammonium. 

Bromide of Ammonium (Ammonii Bromidum, U. S. and B. P.) 
is really a crystalline salt but is generally found in commerce as a 
white, granular powder which, when exposed to the atmosphere, 
becomes slightly yellowish. It is readily dissolved in water. 

Physiological Action. — Applied to the mucous membrane the 
bromide of ammonium produces a salty taste and is markedly pun- 
gent, dissolving readily in the liquids of the mouth. If large 
amounts are swallowed it causes burning pain in the belly and 
evidences of gastro-enteritis. 

Nervous System. — The action of this drug upon this part of the 
body is its most important effect. Given to the lower animals it 
produces in frogs total loss of reflex activity, preceded, it is said, in 
some cases by tetanic convulsions, although no such motor disturb- 
ance may take place. According to a series of studies undertaken 
by me to determine the exact effect of the drug, it was found that the 
spinal cord was depressed, both on its motor and sensory side, while 
the nerves and muscles escaped. These results are in accord with 
those of other investigators who also found that the nerves are unaf- 
fected. On the cerebral cortex it acts as a very distinct sedative. 

Circulation. — Upon the circulation bromide of ammonium acts 
as a stimulant in small doses, but as a cardiac paralyzant if a large 
amount comes in contact with the heart. In medicinal dose it is 
distinctly stimulant to the circulation. 

Therapeutics. — The bromide of ammonium may be used in nearly 
every instance where bromide of potassium may be employed, and 
possesses the distinct advantage of being less depressant to the 
general system. It is, however, no less apt to disorder the stomach 
even if given in moderate dose. In epilepsy it would seem to be of 
as much value as the potash salt and may be combined with it in 
some cases with success. (See article on Epilepsy.) According to 
Da Costa, the drug is of very distinct value in rheumatism in the 
dose of 60 to 80 grains a day well diluted, although its manner 
of action in this disease is not known. As just stated, ammonium 
bromide is of value in exactly the same cases as bromide of potas- 
sium, and a free discussion of its uses will be found under that drug. 
The dose is 10 to 30 grains. It is incompatible with spirit of nitrous 
ether. 



52 DRUGS, 



Carbonate of Ammonium. 

Carbonate of Ammonium (Ammonii Carbonas, U. S. and B. P.) 
undoubtedly has an action exactly like that of the liquid prepara- 
tions and is used either alone or with the chloride in the treatment ot 
bronchitis, particularly in babies and young children. The dose is 2 
to 10 grains in syrup of acacia. It is a rapidly acting cardiac and 
respiratory stimulant. 



Chloride of Ammonium. 

The Chloride or Muriate of Ammonium (Ammonii Chloridum r 
U. S. and B. P.) has an entirely different action and therapeutic use 
from the rest of this group. It possesses almost no influence over 
the heart and respiration but does exercise a very stimulant effect on 
mucous membranes, increasing the discharge of mucus and producing 
a free secretion. The consideration of its use in diseases of the 
lungs can be found in the articles on Pneumonia and Bronchitis 
It has been employed in intermittent fever, but has gone out of 
use, and also in neuralgias of the ovarian type, by Goodell and 
others. In chronic torpor of the liver and hepatitis, and even in 
cirrhosis and hepatic abscess, it has been thought of value. Many 
clinicians have found it useful in gastric and intestinal catarrhs of 
children of a very subacute type and it is the routine treatment for 
all such cases which come under treatment at the Children's Depart- 
ment of the University of Pennsylvania and elsewhere where the 
author has charge. The dose is 2 to 15 grains, preferably given with 
liquorice and water to mask the taste. 



Iodide of Ammonium. 

Iodide of Ammonium (Ammonii Iodidum, TJ. S.) may be employed 
in the dose of 2 to 3 grains in all cases where the iodide of potash 
is indicated, and seems to possess equal alterative influences. It has 
been recommended as a local application in cases of enlarged tonsils 
in the form of a solution of 30 grains of the salt to the ounce of 
glycerin, particularly if struma is the cause of the enlargement. The 
application is to be made once a day with swab or camel's-hair brush. 
It is necessary that this solution be not exposed to the air or it will 
decompose. 



AMYL NITRITE. 53 



Valerianate of Ammonium. 

Valerianate of Ammonium (Ammonii Valerianae, U. S) is the salt 
of ammonium commonly used in the nervous unrest of pregnant or 
hysterical women, or at the menopause in the peculiar nervous dis- 
orders of that period. In poisonous doses it paralyzes the spinal cord 
in the lower animals. It is usually given in the form of the elixir 
of the valerianate of ammonium, the dose of which is a teaspoonful 
to a dessertspoouful, or it is combined with the bromides, under 
which circumstances it is much more efficacious. The dose of the salt 
itself is 10 to 15 grains. 

AMMONIAC. 

Ammoniac (Ammoniacum, U. S. and B. P.) is a resinous gum 
obtained from Dorema Ammoniacum and is used very little in medi- 
cine at the present time. Internally and externally it produces some 
irritation when brought in contact with the tissues and may be used 
internally in the dose of 10 to 30 graius in pills in cases of old 
bronchitis devoid of any true inflammatory process. It is officinal 
in the form of the plaster of ammoniac {Emplastrum Ammoniaci, 
U. S. and B. P.), which is used as a stimulant plaster over enlarged 
glands and joints, and as the plaster of ammoniac and mercury {Em- 
plastrum Ammoniaci cum Hydrargyro, U. S. and B. P.), which is 
used for the same purpose, and finally there is the mixture of ammo- 
niac (Mistura Ammoniaci, U. S. and B. P.) used in chronic bronchitis, 
in the dose of a tablespoonful. 



AMYL NITRITE. 

Amyl Nitrite (Amyl Nitris, U. S. and B. P.) is a very volatile, 
somewhat oily, liquid possessing a peculiar penetrating pear-like 
odor. It is made by the action of nitric and nitrous acids upon 
amylic alcohol, and it is not to be confounded with nitrate of amyl, 
which has a different physiological action and is never used medici- 
nally. 

Physiological Action. — When swallowed or inhaled the drug pro- 
duces staggering, fulness in the head, roaring in the ears, duskiness 
of the face, and finally utter muscular relaxation, so that the animal 
or man falls to the ground. The heart beats very rapidly and forcibly 
and the respirations become gasping. 

Nervous System. — Nitrite of amyl acts as the most rapid of all 
the nervous depressants and sedatives known except prussic acid. 



54 DRUGS. 

Experiments show that its dominant action is on the motor cortex 
of the brain and the motor nerves, as well as the motor side of the 
spinal cord. Upon the nervous apparatus of sensation nitrite of 
amyl has no effect in medicinal amounts and can never be used to 
relieve pain unless it be due to spasm or to angina pectoris. The 
muscles are, however, depressed by large amounts. 

Circulation. — When nitrite of amyl is used the pulse becomes 
exceedingly rapid, while the arterial tension progressively falls. The 
increase in pulse-rate is due to depression of the inhibitory apparatus 
of the heart and to the sudden relaxation of the bloodvessels, by reason 
of which, the resistance being taken away, the heart beats faster. 
The fall of arterial pressure is due to a depression of the vaso-motor 
centres and the muscular coats of the bloodvessels. In very small 
amounts the drug stimulates the heart muscle (Reichert), but its 
dominant action is that of a depressant. 

The Blood. — In medicinal dose this drug causes a chocolate 
color of the arterial blood due to the change of oxyhemoglobin into 
methsemoglobin. 

Urine and Elimination. — The urine nearly always contains 
sugar after the use of the nitrite of amyl aud there is increased 
diuresis. The drug is eliminated very rapidly from the body by the 
lungs and kidneys. In the urine it is formed into a nitrate if nitrite 
of potassium be employed. 

Temperature. — If the nitrite of amyl be inhaled for any time 
the most remarkable fall in temperature ensues, probably due to 
diminished oxidation but possibly to -some effect on the heat centres. 
The vascular dilatation also tends greatly to aid in the fail of bodily 
heat. 

Therapeutics. — Nitrite of amyl is used to relax general or local 
muscular spasms, for the relaxation of the spasm of epilepsy and for 
aborting an on-coming fit, for the prevention and subjugation of strych- 
nine convulsions and tetanus, and for the relief of angina pectoris. 
It may be used in puerperal eclampsia, but it is a dangerous remedy 
because of its relaxation of the uterus and the consequent danger of 
post-partum hemorrhage. In dysmenorrhea with uterine spasm it 
often gives great relief. In cardiac failure from fright or anaes- 
thetics it is often of great value in single whiffs. If it does not act 
at once under these circumstances it is worse than useless to push it. 
It has also been found of value in whooping-cough, laryngismus strid- 
idus, asthma, spasmodic croup and infantile convulsions. In migraine 
with local vaso-motor spasm and true hemianopsia it is very useful. 
In strychnine poisoning and tetanus it must be used between the 
spasms or else given hypodermically, as the respiratory cramp pre- 
vents its inhalation. 

Administration — The drug is usually given by placing three to 
five drops on a handkerchief and inhaling the fumes, or it may be 
dropped on sugar and taken by the mouth in the same quantity. 



ANTIMONY — TARTAR EMETIC. 55 

It is important to remember the fact that the effects of the drug 
are more severe for a moment after its use thau during its inhalation. 

The best way for patients to use the drug is to have it in pearls of 
glass, each holding 3 minims. One or more of these may be crushed 
in the handkerchief and inhaled. 



ANTHRAROBIN. 

Anthrarobiu, which was originally discovered by Liebermann, 
seems to possess equal value with its relative ehrysarobin, and to be 
capable of substitution for this substance in the treatment of skin 
diseases. It is a yellowish powder, tolerably stable in a dry atmos- 
phere, and is not soluble in acids or water, but readily soluble in 
dilute alkaline solution or alcohol, at first making a solution of a 
brown color, which as oxygen is taken up passes to a green, and, 
finally, to a violet. 

Therapeutically, anthrarobiu has been employed by Kosenthal and 
by Behrend, and more recently Kobner has recorded his experience 
with it, employing it with good results in a 10 to 20 per cent, solu- 
tion in the various forms of tonsurans as a wash. Rosenthal has 
used it in psoriasis and pityriasis versicolor and herpes, and Behrend 
asserts that it is often better in its effects upon the skin than chrys- 
arobin, as it produces less inflammation and only discolors the skin 
slightly. It also possesses the additional value of making so slight 
a stain on the linen that it can be removed by washing. 

According to most authorities, it is best to keep it in alcoholic 
solution, and, if the bottle is well corked, such a mixture remains 
good for a week. 

ANTIMONY. 

Antimony itself, or its oxide, is never used in medicine, owing to 
its insolubility, but is generally employed as the tartrate of antimony 
and potassium or Tartar Emetic (Antimonii et Potassii Tartras, U. S.), 
or in the form of the sulphide (Antimonii Sulphidum, U. S.); purified 
sulphide (Antimonii Sulphidum Purificatum, U. S.; Antimonium 
Nigrum Purificatum, B. P.); and sulphurated antimony (Antimonium 
Sulphuratum, U. S. and B. P.). The latter are so rarely employed 
and are such unreliable and useless preparations that they will 
probably be dropped in the present revision of the Pharmacopeia. 

Tartar Emetic. 

Tartar Emetic (Antimonii et Potassii Tartras, U. S.; Antimonium 
Tartaratum, B. P.) is made by boiling the oxide of antimony with 



56 DRUGS. 

bitartrate of potassium and water. Although it is really crystalline 
it is generally sold as a fine powder, owing to these crystals being 
easily pulverized. It is insoluble in absolute alcohol but soluble in 
ordinary water and still more so in boiling water. In dilute alcohol 
it is partly soluble. 

Owing to its chemical constitution tartar emetic should never be 
given with either acids or alkalies, and all drugs containing tannic 
acid are also incompatible with it, owing to the fact that an insoluble 
tannate is rapidly formed which is absorbed very slowly if at all. 
So complete is the insolubility of the compound so formed that tannic 
acid is the best antidote to the drug that we possess. 

Physiological Action. — Tartar emetic, when applied to mucous 
membranes, produces a burning sensation, while upon the skin it 
may readily cause a large amount of irritation if the part be delicate. 
If kept in contact with a mucous membrane very distinct inflam- 
matory changes occur, and if it be applied to the skin constantly, red- 
ness, followed by acne of a pustular character, appears, which finally 
ends in ulceration and sloughing if the use of the drug is persisted in. 
Under these circumstances the vitality of the parts seems interfered 
with, and, as a result, healing takes place very slowly indeed. 

Nervous System. — Antimony is a depressant to the sensory side 
of the spinal cord aud a paralyzant to all the spinal centres, motor 
and sensory, in poisonous dose. 

It is stated that sensation to heat and acids are lost before the 
ordinary sense of touch is destroyed. The convulsions which some- 
times ensue after poisonous doses in- the lower animals are due to 
ansemia of the brain brought on by the circulatory depression. 
Ringer and Murrell have proved antimony to be a motor-nerve and 
muscle poison. 

Circulation. — The chief influence of antimony is exerted upon 
the circulation. In small doses it lowers the pulse-rate by a direct 
depression of the heart muscle and simultaneously decreases arterial 
tension by an action upon the peripheral portions of the vaso-motor 
system in the walls of the bloodvessels, but the vaso-motor influences 
may be centric, and this point can only be considered as subjudice. 

Along with the lowering of the pulse-rate there is nearly always a 
corresponding decrease in cardiac power. When poisonous doses are 
employed death ensues after great circulatory and respiratory depres- 
sion, as will be seen below. The heart is found relaxed and flabby 
and utterly dead to all stimuli, although if the dose has not been 
very excessive and digitalis be freely employed the heart may be 
made to beat again, at least in the frog. The drug in these doses is 
thought to depress the peripheral ends of the vagus nerves. 

Respiration. — The drug has little or no effect upon respiration 
except when given in doses not medicinal. Under these circum- 
stances death is produced in three ways, all of them acting together. 
Primarily, the respiratory centre in the medulla is depressed, and 



ANTIMONY — TARTAR EMETIC. 57 

the governing nerves of breathing, the pneumogastrics, are also inac- 
tive ; secondarily, the cardiac failure readily causes pulmonary con- 
gestion ; and, thirdly, the drug causes such an outpouring of liquid 
and mucus into the bronchial tubes that the patient is drowned in his 
own sputum, which he is too weak to expel. 

Stomach and Intestines. — Antimony in toxic doses is a power- 
ful irritant to these portions of the body. In full medicinal amounts 
it acts as a slow but powerful emetic, producing much nausea. The 
vomiting is clue to an action on the vomiting centre in the medulla 
and to a direct action on the stomach itself. The drug is, therefore, 
a centric and peripheral emetic. 

Very full doses produce watery purging attended with some 
griping and tenesmus. 

Elimination. — Antimony escapes from the body in all the secre- 
tions, but largely by the bowels. The latter method seems chiefly 
to follow poisonous doses, and Wood believes with others that purging 
is an effort at elimination. 

Poisoning. — When toxic doses of tartar emetic are taken the pulse 
at first becomes slightly weaker and slower, the skin becomes moist 
and relaxed, a general sense of relaxation comes on and simulta- 
neously a sensation of severe nausea and gastric distress appears. 

Following this condition violent vomiting asserts itself. The 
ejected mass consists of the contents of the stomach, mucous, bile, and 
watery fluids, and perhaps blood. Purging appears almost as early as 
the vomiting and consists first of the contents of the intestines, then 
mucus, then bile, and, very rarely, blood. These signs very rapidly 
disappear aud the characteristic peculiar " rice-water" stools 1 come on. 
The general condition of the patient is now most serious, the face is 
pinched, livid and covered with cold sweat. The pulse is rapid and 
shuttle-like — to and fro — or lost at the wrist ; the arterial tension is 
almost nil. The respirations are faint aud fluttering and so shallow 
as hardly to be seen. Cramps in the calves of the legs attack the 
patient, due to the abstraction of water from the tissues by the 
violent purging, and the temperature falls lower and lower as death 
approaches. The general condition is such that all the signs point to 
Asiatic cholera, and it cannot be separated from this disease without 
a history of the case or a chemical analysis of the secretions, which 
ought always to be preserved. 2 

The treatment of antimonial poisoning consists in the internal 
administration of large amounts of tannic acid, in the use of the 
stomach-pump, and in the maintenance of an absolutely prone posi- 

1 A " rice-water" stool is one "which, on standing in a glass, separates into two layers, 
the lower white and flocculent, the upper almost clear and watery. 

2 This is probably as good a place as will occur to state that the receptacles which 
receive the secretions and excretions of a person dying of any poison should be placed 
in a chemically-clean jar capable of being sealed tight. The same rule applies to the 
jars holding organs at the post-mortem. The jars should be ready and no intermediate 
vessel used. They should be sealed at once and kept so until claimed by the authorities. 



58 DRUGS. 

tion. The patient should vomit into towels and not raise the head 
from the ground ; the head, indeed, should generally be placed below 
the heels. External heat, alcohol, and digitalis should be thor- 
oughly used, and opium should be employed hypoclermically to allay 
pain and irritation unless respiration is too feeble. 

Fatty degeneration of the tissues may occur after the poisoning. 

Therapeutics. — Tartar emetic is employed for at least five separate 
purposes, the most usual of which is as a circulatory quieter and 
sedative. The indications for antimony as a circulatory depressant 
are not so generally recognized at present as they were at one time, 
on account of the introduction of other drugs. Suffice it to state that 
all states of sthenic inflammation with a bounding pulse, high fever, 
and symptoms of robust constitution permit of its use, while all 
asthenic conditions most emphatically contra-indicate its employment. 
In colds, to break forming diseases, and to allay inflammation, it is 
given in moderate dose. It is useful in sthenic bronchitis as an 
expectorant, Under these circumstances it may be given in emetic 
dose ; or, if emesis is not desirable, minute amounts given hourly 
are of value, such as -fa of a grain every hour, or a teaspoonful of 
a solution of 1 grain to a half-pint every hour may be used. This 
is a particularly useful method in children, as it is tasteless and does 
not produce nausea and vomiting. 

In acute catarrh of children affecting the stomach and entire 
alimentary canal and associated with little fever, the use of the drug 
as just described is extremely valuable, and often aborts an attack in 
the same dose. 

As an emetic it is slow but forcible and ought not to be used in 
poisoning owing to its slowness. Before the introduction of anaes- 
thetics emetic doses were employed to relax the muscles in reducing 
dislocations and fractures. 

Tartar emetic is harmful if irritation of the stomach is present or 
if kidney lesions are active, and if one good-sized emetic dose is not 
sufficient to produce vomiting it should not be repeated. This dose 
should be large enough to be effective or none at all be given. If 
this rule is disobeyed systemic changes come on with undesired force 
in those cases where emesis fails to occur. 

As a counter-irritant antimony is employed in the form of an oint- 
ment whenever a very slowly acting and prolonged counter-irritation 
is to be attained, as in epilepsy or similar chronic states, and in old 
enlargements of the joints. 

Antimony as a diaphoretic is useful, but unnecessary owing to its 
disagreeable effects, such as nausea and intestiual disturbance. 

Administration. — The dose of tartar emetic, when there is an 
excited circulation, is -fa to fa of a grain every three hours till an 
effect is obtained. As an emetic the dose is J to 1 grain. The wine 
of antimony ( Vinum Antimonii, U. S. ; Vinum Antimoniale, B. P.) 
only contains two grains of tartar emetic to each ounce and may be 



ANTIPYRINE. 59 

used in the close of J to 1 teaspoonful or, as an emetic, in the close of 
1 to 2 tablespoon fills. The compound pill of antimony (Piluke 
Antimonii Composite?, U. S.) contains sulphurated antimony, calo- 
mel, guaiac, and tragacanth ; the dose is 1 to 3 pills. 

The ointment of antimony ( Unguentum Antimonii Tartarati, B. P.) 
is used externally as a counter-irritant spread on a rag or piece of 
lint. Autimonial powder (Pulvis Antimonialis, U. S. and B. P.) 
or James's powder contains oxide of antimony and phosphate of 
calcium and is given occasionally as an antipyretic in rheumatism 
and fever in the dose of 3 to 10 grains. 

The compound syrup of squill (Syrupus Scilke Compositus, U. S.), 
otherwise known as " Coxe's Hive Syrup/' contains three-fourths of 
a grain of tartar emetic to the ounce. The dose is 20 to 30 drops for 
an adult as a sedative, or from this amount to a drachm to a child 
as an emetic. Liquor Antimonii Chloridi, B. P., is not officinal in 
this country, and in England is rarely used as an escharotic. 



ANTIPYRINE. 

Antipyrine is a derivative of coal tar, its chemical name being 
dimethyloxyquinizine. In appearance it is a white powder of a 
somewhat bitter taste and is very soluble in water, less so in ether, 
alcohol and chloroform. The process by which it is made is patented, 
and unlike that of its rival, acetanilide, is unknown except to the 
manufacturers. 

When antipyrine is given to man in full medicinal amount it 
causes a buzzing and tightness of the head not unlike that produced 
by quinine. The bodily temperature, if normal, is depressed a frac- 
tion of a degree, but no other symptoms are manifested. If the dose 
be quite large some blueness of the lips and finger-nails appears, 
chilly sensations are experienced, and finally a profuse sweat breaks 
out over the entire body, which is more severe if fever has previously 
existed. Larger doses sometimes cause nausea and vomiting. 

Physiological Action : 

Nervous System. — When a poisonous dose is given to one of 
the lower animals, relaxation, utter loss of reflex action, and total 
inability to move come on at once and death ensues. Somewhat 
smaller doses produce exceedingly severe tetanic and epileptiform 
convulsions, but consciousness seems to be preserved. It has been 
proved that the chief cause of the convulsion is an action of the 
drug on the brain. 1 Very large toxic doses, therefore, decrease 
reflex action and smaller ones increase it, though medicinal amounts 
certainly lessen reflex activity to a notable degree. The cause of this 

1 See my Essay on Antipyretics, Philadelphia, 1890. 



60 DRUGS. 

failure of reflexes is depression of the sensory nerves and the receptive 
centres of the spinal cord. Medicinal amounts must, therefore, be 
regarded as very distinct nervous sedatives, acting much more actively 
on the nerves of sensation than on those of motion. 

Circulation. — The studies of a very large number of pharma- 
cologists and clinicians prove most conclusively that antipyrine has 
no effect on the circulation in moderate doses, unless these be so fre- 
quently repeated that cumulative effects ensue. Large, poisonous 
doses lower blood-pressure, unless convulsions are present, when the 
pressure is raised. The action of the drug on the circulation is a 
very unimportant part of its power, and is not generally to be con- 
sidered in disease. In the cases where vascular depression and col- 
lapse have followed its use it has been employed in excessive amounts, 
or the fall in bodily temperature has caused the untoward influences. 
(See Fever and its Treatment.) 

Blood. — No spectroscopic changes in the blood follow the use of 
medicinal doses of antipyrine in the ordinary individual, but in 
poisonous amounts it produces methaemoglobin. If the doses be 
toxic, or idiosyncrasy exists, cyanosis may come on. That the blood 
is not influenced by small amounts is proved by the absence of 
hsematin in the urine of persons taking the drug. The corpuscles 
suffer no changes except in very pronounced poisoning, when they are 
said to become crenated and shrivelled. 

Respiration. — When antipyrine is given in lethal doses death 
results from failure of the respiratory centre. Ordinary doses have 
no effect on this function, but large -ones make the breathing more 
rapid. 

Temperature. — In normal men and animals antipyrine may be 
considered as without effect so far as normal bodily temperature is 
concerned. In fevered animals it has been found to lower tempera- 
ture by decreasing heat production and increasing heat dissipation. 
That it does not do this by an action on the blood seems proved by 
the fact that the blood is not affected by medicinal amounts. The 
sweating does not cause the fall, since it takes place when no sweating 
occurs. It may, therefore, be considered that the drug directly 
affects the nervous heat mechanism of the body. 

Kidneys, Tissue- waste, and Urine. — A very large number of 
studies made upon man and the lower animals by competent investi- 
gators have brought about very considerable advances in our knowl- 
edge of the influence of antipyrine upon tissue waste. It is useless 
to burden this volume with a discussion of their methods and results, 
which may be found in my Essay on Antipyretics ; l suffice it to say 
that while all observers are not agreed as to the effects produced, the 
deductions apparently to be drawn are that the drug diminishes the 
quantity of the urine excreted, and also decreases the elimination of 

i Philadelphia, 1890. 



ANTIPYKINE. 61 

the nitrogenous materials, or, in other words, is a conservator of the 
tissues of the body. 

Elimination. — The elimination of antipyrine goes on very rapidly 
indeed, and begins almost at once after its ingestion. Maragliano 
states that it appears in the urine in three hours after it is taken. 
At the fourth hour elimination is at its height, and it continues for 
twenty-four or thirty-six hours. According to Pavlinow, part of the 
antipyrine ingested is eliminated by the salivary glands. 

Toxic Effects from Prolonged Use. — Under these circumstances a 
post-mortem examination shows intense engorgement of the brain 
and meninges, with a serous exudate into the cerebral ventricles. 
The lungs are highly congested, the spleen is small and shrivelled, 
and the kidneys filled with blood and slightly inflamed. The liver 
is not much affected, but the blood corpuscles are greatly decreased 
in number. 

Poisoning. — The treatment of poisoning by antipyrine consists in 
the administration of stimulants, the maintenance of bodily heat, the 
use of atropine to restore the tone of the vascular system, and if 
cyanosis is alarming, oxygen inhalations. 

Antiseptic Power. — Antipyrine exerts a very distinct antiseptic 
action iu small amounts, delaying all forms of fermentation and pre- 
venting the growth of germs when present in large quantity. 

Therapeutics. — Antipyrine is employed in medicine for two great 
purposes — namely, for the reduction of fever and the relief of pain. 
Indeed, its employment as an antipyretic is now entirely surpassed 
by its action as an analgesic. 

As an antipyretic antipyrine should be given in a few large doses 
rather than frequent small ones, as a general rule, since if the fever 
is of any severity the latter method of administering it will be of 
no effect. On the other hand, too large doses may depress the tem- 
perature to a point below normal, and induce collapse. In the 
article on Fevers and their Treatment are indicated the affections in 
which the drug is best employed, these being the sthenic fevers, as 
a rule, or instances where excessive outbursts of fever necessitate 
prompt action in reducing temperature. Under these conditions, 
antipyrine is the best adjunct to the cold pack. In excessively 
high temperature in pneumonia it is of great value, and in scarlet 
fever and smallpox is of service in some instances. In pneumonia, as 
a rule, the fever indicates at first cardiac depressants rather than 
antipyretics. In phthisis antipyrine generally increases the sweating, 
produces oppression, and either fails to act at all or produces collapse 
by too great an effect. In sunstroke it frequently fails to influence 
the temperature. 

Be the fever what it may, provided it be associated with any dis- 
eased process, antipyrine is absolutely useless so far as any influence 
over the course of the disease itself is concerned. It is a remedy to 



62 DRUGS. 

be used in the treatment of symptoms, not in the removal of the 
cause of the fever. 

As au analgesic it is the peer of opium. Although the latter drug 
will relieve all forms of pain if it be pushed, it possesses many 
disadvantages not found in antipyrine. In deep-seated pains due 
to organic disease of the organs of the body, in inflammations and 
similar disturbances, antipyrine is useless. In neuralgic affections 
of all kinds it finds its sphere, particularly if the nervous trouble 
be rheumatic, gouty, or due to nervous depression. Under the latter 
circumstances it is best combined with caffein and a little bromide 
of potash (see Neuralgia). In rheumatism it will give relief in 
a fairly large number of cases, not only relieving the pain and 
fever, if it be present, but also actually modifying the disease. It 
seems, however, to increase sweating in acute articular rheumatism. 
In gout it is stated to have a specific curative effect upon the disease, 
over and above the relief of the pain. Its use in dysmenorrhea has 
has been recommended, but its beneficial influence in such cases is 
doubtful. At one time it was thought that its use would relieve the 
pains of labor entirely, but this has, unfortunately, proved untrue. 
It may, however, be tried when the suffering is very severe in the 
dose of 15 grains. In the severe lancinating or darting pains of 
locomotor ataxia, and in the laryngeal and gastric crises complicating 
this disease, it is au invaluable and reliable remedy. Curiously 
enough it seems to affect acute attacks of pain in posterior sclerosis, 
but fails to control the slighter pains and muscular twitchings some- 
times seen in this disease and in myelitis. 

Antipyrine may be used hypodermically in the case of a hyper- 
sensitive nerve as a local anaesthetic. The anaesthesia produced by it 
lasts for several days, but the pain immediately after the injection is 
excruciating. 

According to Wood and others, antipyrine is a very useful remedy 
in epilepsy. 

In malarial diseases antipyrine certainly exercises no antiperiodic 
influence, although it controls the febrile paroxysms to a great extent. 
Yet, while this is the opinion of the majority of those who have used 
it, it cannot be said that every observer has reached similar conclu- 
sions. Potter reports cases where the results obtained were most 
satisfactory, particularly in the intermittent form of malarial poison- 
ing. One cannot help thinking that frequently where antipyrine 
has been reported as acting as an antiperiodic, it has simply lowered 
the fever and so seemed to affect the disease. 

Untoward Effects. — Aside from the results of poisonous doses, 
a large number of cases present slight cyanosis or duskiness of the 
hands and of the face about the nose and lips ; the fingers may be 
cold and clammy, and the feet are often very cold ; sweating is a 
very common symptom of the untoward influence of antipyrine, and 
pricking of the skin or tingling is not uncommonly seen. By far the 



ANTIPYRINE. 63 

largest number of these cases, however, suffer from disorders associated 
with the skin, and erythematous patches may be seen everywhere, 
more particularly 011 the hands and feet, and about the face, arms, 
and chest. Occasionally pemphigus-like spots appear, aud often 
large bullae have been noted as present. Elsewhere are published 
the statistics, collected from medical literature, of 121 cases of unto- 
ward effects exercised by antipyrine. 1 An analysis of these shows 
that females were much more frequently affected than males, and 
that the most susceptible age was decidedly that of full adult life — 
namely, from thirty to forty years, in both sexes. The dose causing 
these effects was most commonly a moderate one — either from 10 to 
15 grains, or even from 4 to 10 grains. This holds good with regard 
to both sexes. The time of onset varied somewhat, according to 
whether the drag was given in one excessive dose or in frequently 
repeated medicinal doses. In other instances, however, the appear- 
ance of the symptoms was sudden rather than gradual, and as a rule 
the duration of the symptoms did not exceed more than one to three 
hours, three days being the longest time mentioned. It is interesting 
to note, however, that of all these cases only six proved fatal, and iu 
these there was ample cause for death aside from any effect of the 
drug. We can rest assured, therefore, iu ordinary cases of disease, 
that patients exhibiting untoward effects of antipyrine are not in any 
acute danger, although the symptoms may be temporarily most alarm- 
ing. Typhoid fever seems, according to the statistics collected by 
the writer, to be the disease in which this unexpected influence 
manifests itself most frequently, but this may be due to the fact that 
it is so common a malady, and so frequently treated by means of 
antipyretics. 

Administration. — Owing to the solubility of antipyrine it is most 
readily given in a little water in a wineglass or spoon. If its slight 
taste is disliked it may be dissolved in any one of the aromatic 
waters, or in syrup of bitter orange peel, or some similar vehicle. 
Most persons prefer to take it with ordinary water. The amount 
which may be given at a dose is 5 to 20 grains, 5 grains being perhaps 
the best dose for most cases. 

Incompatibles. — When added to sweet spirit of nitre antipyrine 
in the course of a few moments produces a blue, changing to a dark 
green, color owing to the formation of iso-nitroso-antipyrine, which 
is not poisonous, but when in the form of a dry powder is readily 
oxidized on exposure to slight heat. If this color is not formed the 
spirit of nitre lacks its nitrous ether and is worthless, so that we 
have not only another incompatibility to remember, but a new means 
of testing the therapeutic value of all samples of sweet spirit of 
nitre which may be dispensed by druggists. 

1 See my Essay on Antipyretics. Philadelphia, 1890. 



64 DRUGS. 

APIOL. 

Apiol is a yellowish, oily liquid with a specific gravity greater 
than water, an acid taste, and curious odor. It is derived from 
common parsley or petroselinum. So far as is known to the author, 
no careful study of its physiological action has ever been made, but 
two French observers, Joret and Homolle, state that in overdose it 
causes ringing in the ears, intoxication, and severe frontal headache. 

Therapeutics. — Originally introduced to combat malarial fevers, 
because of a fancied resemblance in its toxic action to quinine, apiol 
has at last found its true level as a remedy in amenorrhea, given in 
the dose of 2 to 3 minims three times a day for a week before the 
proper date for menstruation. It should be given, if possible, in 
capsules owing to its bad taste. It is said not to possess any abor- 
tive influences, although it is often taken with that object in view. 

Apiol is imported from France in capsules containing a little less 
than 3 grains. 

APOMORPHINE. 

Apomorphine is an artificial alkaloid obtained by the action of 
hydrochloric acid upon morphine in a sealed tube to which is applied 
a high heat. It is a whitish or gray powder, made up of minute 
crystals, which rapidly undergoes decomposition when exposed to the 
air, The drug should be kept in dark bottles well stoppered. A 
very important point to remember is that old solutions rapidly 
decompose, and may produce poisonous symptoms if employed in 
medicine. The drug ought to be dissolved freshly each time it is 
used. 

Physiological Action. — One of the best studies of this drug is 
that of Reichert, who found that in poisonous doses it produces con- 
vulsions, and finally paralysis, which is chiefly spinal in origin. 

Nervous System. — On the nervous centres in the brain apo- 
morphine acts as a stimulant, but the convulsions produced by 
poisonous doses are probably spinal. The motor and sensory nerves 
are finally paralyzed, and even the muscles become poisoned and 
incapable of contraction. 

Circulation. — Apomorphine increases the rapidity and force of 
the pulse and raises arterial pressure when given in moderate amounts 
by stimulation of the accelerator nerves and the vaso-motor centre. 
Large doses act as circulatory depressants. 

Respiration. — After ordinary amounts no change in respiration 
occurs, but after poisonous doses the breathing becomes rapid and 
irregular. 



ARNICA. 65 

Vomiting. — This is produced by a direct action of the drug upon 
the vomiting centre in the medulla, and not by an action on the 
stomach. Apomorphine is, therefore, a typical centric emetic. 

Therapeutics. — Apomorphine is useful in nearly all cases where an 
emetic may be employed. In poisoning from other drugs, particu- 
larly depressants and narcotics, we have little knowledge of its 
safety, but, unless the stupor or circulatory changes are very pro- 
found, the drug may be used with care. In subacute and chronic 
catarrh of the stomach and air-passages it may be useful in getting 
rid of the mucus, and it is a useful remedy in bronchitis where it is 
necessary to excite secretion, or where the secretion which has been 
poured out is tough and thick. 

Administration. — The drug when used as an emetic should always 
be given hypodermically and the solution be freshly prepared. The 
emetic dose is about ^ of a grain, but as much as -J- may be used. 
The expectorant dose is -1- to -^ of a grain by the mouth. No nausea 
is usually felt. The drug nearly always acts badly -in children, and 
had better not be used in this class of patients. The salt used is 
Apomorphince Hydrochloras, U. S. and B. P. An injection (Bijectio 
Apomorphince Hypodermica — 2 grains dissolved in 100 minims of 
camphor- water) is officinal in the B. P. 



ARISTOL. 

Aristol is a compound of iodine and thymol, which has been 
introduced into medicine for the purpose of substituting iodoform. 
Experiments and practical clinical experience has shown that it can 
be used in all instances where iodoform can be applied externally, 
and it is said to possess the advantage of being almost entirely 
harmless to man, although it is a powerful parasiticide. As a 
dressing for the ulcers of tertiary syphilis it seems to act with 
remarkable rapidity, producing cicatrization with greater rapidity 
than does iodoform, and it has also been found of value in the 
treatment of lupus. Aristol may be used in the place of chrvs- 
arobin or pyrogallic acid in the treatment of psoriasis. It is best 
employed in the form of an ointment in the strength of J- to 1 
drachm to the ounce of vaseline. 



ARNICA. 

Arnica is a medicine derived from arnica montana, a native 
plant of the Western United States and Europe. It holds a very 
high position in domestic medicine as a local and internal remedy in 
sprains and bruises, and in hcemorrhages, amenorrhea, and similar 

5 



66 DRUGS. 

states. Two parts of the plant are officinal, the arnica flowers 
(Arnicas Flores, U. 8.) and the root (Arnicas Badix, U. 8., Arnicas 
Mhizoma, B. P.) 

Physiological Action. — When arnica is applied to a delicate skin 
it produces burning and irritation, and even extensive skin lesions. 
According to the studies of the author it slows the pulse, raises the 
blood-pressure slightly, aud stimulates the vagus nerves. Toxic 
doses produce a rapid pulse from paralysis of these nerves. 1 

Administration. — Internally it is rarely given. If it is so used 
the dose of the tincture (Tinctura Arnicas Badicis, U. 8.) is 15 to 30 
drops, and the same amount of the tincture of the flowers (Tinctura 
Arnicas Elorum, U. 8.) is to be used. The solid (Extractum Arnicas 
Badicis, U. 8.) and fluid extract (Extractum Arnicas Badicis Fluidum) 
of the root are also officinal. The dose of them is 3 to 5 grains and 
5 to 10 minims respectively. The plaster (Emplastrum Arnicas, U.S.) 
is very useful for external applications. 

The tincture is the preparation usually applied to sprains and 
bruises, and the alcohol contained therein accomplishes a large part 
of the good achieved. 

The tincture (Tinctura Arnicas), the only British preparation, is 
given in the dose of 30 minims to 1 drachm. 



ARSENIC. 

Arsenic (Arsenicum) itself is never employed in medicine, but it is 
used in the form of arsenious acid or the arseniates of sodium, 
potassium, or copper. 

Arsenious acid is derived from arsenic-bearing ores by roasting them 
in a reverberatory furnace, when it rises in the form of a vapor which 
adheres to the walls of the furnace, and requires a second sublima- 
tion owing to the first deposit being quite impure. It is soluble in 
water, is without odor, and when heated gives off the smell of 
garlic. 

Physiological Action. — The changes produced by poisonous doses 
in man will be found considered under the heading of Poisoning, 
and the writer will now confine himself to a study of the effects of 
medicinal amounts. 

Applied to the normal skin arsenious acid produces no change of 
any moment whatever, but if the surface be broken or a wound or 
sore exists its action is very powerful, and it destroys the tissues to a 
considerable extent. For this reason it has been employed as a 
caustic by " quacks " and regular physicians, the latter using it to 
remove warts, condylomata, and similar growths, while the former 

1 See Boston Medical and Surgical Journal, 1888. 



ARSENIC. 67 

have chiefly employed it as a " cancer cure," asserting that it would 
take the disease u out by the roots." 

Nervous System. — When small amounts of arsenic are given to 
animals, particularly of the lower types, as represented by the frog, 
reflex action is lost long before, or more rarely at the same time that 
voluntary movement is put aside, and, finally, all sensation to pain 
produced by heat and pinching totally ceases. It is, therefore, quite 
evident that the sensory nervous apparatus is affected, and experiments 
have proved that the sensory tract of the spinal cord is at fault. 
Ultimately, however, the motor system also fails and complete 
motor palsy ensues. Arsenic acts as a depressant poison to all pro- 
toplasm with which it may come in contact. (Ringer and Murrell.) 
In medicinal amounts the drug acts as a nervous excitant and as a 
stimulant to the trophic nervous apparatus. 

Circulation. — In moderate amounts arsenic has little or no in- 
fluence upon the circulation. Large doses cause marked decrease in 
the force and frequency of the pulse accompanied by a decided fall 
in arterial pressure, and in these amounts it is to be regarded as a 
distinct cardiac depressant which depresses all the heart's component 
parts, such as the ganglia, muscle, and nerves. The fall of the arte- 
rial pressure is due to vaso-motor depression with relaxation of the 
general bloodvessels, but especially those of the abdominal cavity. 
According to Lesser, small doses act as a cardiac stimulant, increasing 
pulse-rate. It is absorbed into the blood. 

Respiration. — In small amounts arsenic stimulates very distinctly 
the respiratory centre, and Lesser asserts that small doses stimulate 
the peripheral ends of the vagi in the lungs, but that in toxic quan- 
tities it acts as a powerful respiratory depressant. 

Elimination. — Arsenic escapes from the body chiefly by the 
kidneys and bowels. In poisoning the purging carries off much of 
the drug, but after medicinal amounts some traces of it may be found 
in the saliva and in the milk of nursing women. The writer has seen 
colic produced in this way in children taking milk at the breasts of 
women taking large doses of Fowler's solution. 

Tissue-waste. — According to Chittenden and Cummins, arsenic 
in medicinal amount distinctly decreases tissue-changes. Large doses, 
however, greatly increase nitrogenous breakdown. 

Therapeutics. — Arsenic is used in chorea, in which it is almost a 
specific, acting in an unknown way. Small doses should be given at 
first and later on its dose should be rapidly increased, as patients 
soon get accustomed to the drug. As a tonic combined with iron 
it is invaluable in malarial ancemia and cachexia. In atony of the 
mucous membranes it is exceedingly useful, and in ordinary anaemia 
and debility, combined with a simple bitter tonic, it is invaluable. In 
malaria it acts as a prophylactic, as a cure, and as a remedy in con- 
valescence. Next to quinine it is the best antiperiodic that we have. 
Where the attacks of intermittent fever are far apart it is useful as an 



68 DRUGS. 

antiperiodic between the paroxysms, quinine being withheld for the 
attack itself. In ordinary neuralgia, due to eye-strain or debility, it 
is very useful. In gastralgia it is of great service. The author 
desires to speak particularly of its employment for the improvement 
of depraved mucous membranes, as in persons who have not true 
tuberculosis but phthisical tendencies — that is, individuals who con- 
tinually have colds in the head, chest, or elsewhere. The prolonged 
use of arsenic for months at a time will often cure these cases. 

Arsenic should never be employed in " wet " skin diseases — that 
is, those associated with much proliferation of new cells and the exu- 
dation of serum and other liquids. Its field is in the dry, scaly skin 
affections. 

Where the skin is affected in its lower layers it is useless and 
should be used only where the epiderm is diseased (Duhriug). 

In psoriasis it at first makes the skin more red and seemingly 
worse, but this passes off and the disease gets well. This is important 
to remember, as otherwise the drug may be stopped just at the wrong 
time. Pemphigus, lichen, and lepra all yield to its influence in most 
instances. 

In diabetes and pruritus vulvce the drug is said to be of value when 
given internally. In gouty diabetes the use of the carbonate of 
lithium and the arseniate of sodium is often of great service. 

In asthma, particularly where the mucous membranes are at fault, 
it is one of the best remedies that we have, given either internally or 
smoked in arsenic cigarettes, which are to be made as follows i 1 

$. — Bellaclonnse folia gr. xcvj. 

Hyoscyam. folia ........ gr. xlv. 

Stramonii folia . gr. xlv. 

Extract, opii : . gr. iv. 

Tabaci . . . gr. lxxx. 

Aquse . Oj. 

M.— Ft. sol. et ad 

Potas. nitrat . gr. clx. 

Potas. arsenitis gr. cccxx. 

Bibulous paper is to be wetted with this compound, and after drying is to be rolled up 
and smoked in a cigarette. 

A more simple procedure is to wet bibulous paper in a solution ot 
arsenite of potassium of the strength of fifteen grains to the ounce. 

In chronic rheumatism asenic is very valuable in certain cases but 
often fails to be of service. In coryzct, in cancrum oris, severe sore- 
throat, and chronic nasal catarrh it is to be employed internally, and in 
some cases of hay-fever affords undoubted relief. The use of arsenic in 
all stages of phthisis gives often the most surprising results. In gastric 
cancer and ulcer, given in small amounts frequently repeated, arsenic 
will often do good by relieving the pain and checking the vomiting. 
It may be tried in the vomiting of pregnancy with some chance of 
success. In atonic dyspepsia associated with chronic diarrhoea, and 

1 See Philadelphia Hospital Pharmacopoeia. 



ARSENIC. 69 

with evidences of dysentery, arsenic is of service. In small amounts 
it is very valuable in frequently repeated doses (y-g-g- of a grain every 
hour), in all forms of serous diarrhoeas. 

In old persons whose feet become swollen and hot from prolonged 
standing and who have shortness of breath on exertion, arsenic does 
good. 

Locally applied to warts and other growths of the skin for several 
days in the form of the Liquor Arsenicalis (B. P.), or Liquor Acidi 
Arseniosi, or of Fowler's solution, it causes the growth to drop off or 
to become very much loosened. Where the growth is very hard 
and horny its surface should be softened by the application of liquor 
potassa befure the arsenical liquor is applied. The same plan may 
be used for corns, and salicylic acid is employed in a similar manner 
but is not so efficient. Where large growths with wide surfaces are to 
be attacked the physician must use arsenic most boldly or not at all. 
The danger of absorption is only escaped when the drug is used so 
generously as to destroy the tissues before they can carry on any 
absorption of the poison. Marsden recommended the use of one 
ounce each of arsenious acid and powdered gum acacia to five drachms 
of water as an application to epitheliomatous growths. 

Administration. — Children generally stand more arsenic than 
adults, proportionately, and Ringer states that boys bear less than 
girls. The drug should generally be given after meals, as it is apt 
to irritate the stomach if used alone. Whenever a patient is under 
arsenic he should be cautioned to watch for any puffiness about the 
eyes, particularly in the morning on arising, and for slight laxity 
of the bowels and griping. These are signs that the drug should 
be stopped for a day or more. The swelling under the eyes may 
spread and amount finally to general anasarca and is due to a cellu- 
litis at first and afterward to a true effusion. 

The officinal preparations are arsenious acid (Acidum Arsenio- 
sum, U. S. and B. P.), the dose of which is -^ to ^V of a grain, the 
solution of the arsenite of potassium (Liquor PotassiiAr senilis, U.S.; 
Liquor Arseniealis, B. P.), or Fowler's solution, the dose of which 
at first is from 1 to 5 drops in water; the solution of arseniate of 
sodium (Liquor Sodii Arseniatis, U. S. and B. P.), the dose of which 
is 1 to 5 drops, and the solution of arsenious acid (Liquor Acidi 
Arseniosi, TJ. S., Liquor Arsenici Hydrochloricus, B. P.), the dose of 
which is 1 to 5 drops. This is more irritant to the stomach than the 
other preparations. The iodide of arsenic enters into Donovan's 
solution (Liquor Arsenii et Hydrargyri Lodidi, U. S. and B. P.), the 
dose of which is 1 to 3 drops well diluted. Iodide of arsenic (Arsenii 
Lodidum, U. S. and B. P.) is given in -^ grain doses, and arseniate 
of sodium (Sodii Arsenias, U. S. and B. P.), in the dose of -^ to j o 
of a grain. 

Acute Poisoning. — Arsenic is a gastro-intestinal irritant, producing, 
when taken in poisonous dose, violent vomiting and purging, with 



70 DRUGS. 

great pain in the oesophagus, stomach, and entire belly. The pas- 
sages are finally watery and resemble " rice-water " stools, but are to 
be separated from those of cholera and antimonial poisoning by the 
presence of blood and by chemical analysis. The mucous membrane 
is stripped off the bowel and appears in shreds. Very commonly 
about the third day, if the patient survive so long, an intermission in 
the attack appears, which will only be followed by a return of all the 
symptoms, so that the physician must not give a favorable prognosis. 
In this symptom arsenical poisoning resembles phosphorus poisoning 
and yellow fever. Death generally occurs about the fourth or sixth 
day, and on or about the third day a peculiar skin eruption appears 
which may be of any character. In rare cases sudden pain, collapse 
and death take place after the ingestion of the poison. Widespread 
multiple neuritis may be brought on. A typical change always present 
in prolonged acute poisoning is fatty degeneration of all the tissues. 

Treatment of Acute Poisoning. — Beside washing out the 
stomach by the stomach-pump, applying external heat and stimu- 
lants, the proper antidotes should be at once employed, and the only 
ones of any value are the freshly precipitated hydrated sesqui- 
oxide of iron and magnesia. The first is to be prepared by the preci- 
pitation of iron from one of its fluid preparations by the use of an 
alkali. Ammonia added to the tincture of the chloride of iron is 
efficacious, but the precipitate has to be repeatedly washed to rid it 
of an excess of ammonia. Magnesia is a better precipitant because 
it not only precipitates the iron but is an antidote itself. MonsePs 
solution and the so-called dialyzed iron may be employed in place of 
the tincture, but the Monsel's salt is too irritating and the dialyzed 
iron is so readily precipitated that it needs no alkali to be added, but 
may be given pure. Magnesia is a useful antidote of itself. 

Under the name Ferri Oxidum Hydratum cum Magnesia the 
IT. S. P. recognizes an antidote for arsenic ; this is often called the 
" antidotum arseniciP 

After the use of the antidote opium should be given to allay irri- 
tation and pain, and large draughts of water be used to flush the 
kidneys and dilute the poison. In its later stages the danger from 
arsenical poisoning arises from the changes produced in vital organs. 

Chronic Poisoning shows itself in great irritation of the air- 
passages, in diseases of the kidneys, in pigmentation of the skin, and 
in nervous symptoms due to inflammations of the nervous tissues in 
different parts of the system, such as patches of anaesthesia and local- 
ized loss of motor power. These anaesthetic areas are generally con- 
fined to the extremities and extend only to the first or the second 
joint above. Arsenic often produces asthma in those exposed to it 
by reason of the irritation it causes in the bronchial tubes. Chronic 
poisoning is to be treated by withdrawal from the exposure, and the 
use of iodide of potassium to aid in the elimination of the arsenic. 



AZEDARACH. 71 

The other symptoms are to be treated by application of electricity, 
tonics, out-of-door life, and such measures as will improve the general 
condition of the patieut. 

ASAFCETIDA. 

Asafoetida, U. S. and B. P., is a gum obtained by making an inci- 
sion into the root of the Ferula Narthex. It occurs in irregular 
masses of a dark yellow or reddish color which becomes still more 
red if exposed to the light and air. Asafoetida in tears is a term 
applied to the drug when it appears in the shape of drops or pearls, 
and is seldom seen. Its odor is penetrating, strong, and resembles 
that of garlic. When taken internally it causes a sensation of warmth 
and acts as a stimulant and carminative in the alimentary canal. 

Therapeutics. — Asafoetida is used in medicine as a carminative 
which will particularly affect the lower bowel, and is useful in the 
intestinal indigestion of old persons when associated with flatulence, 
and in the flatulent colic of children. By way of rectal injections it 
is of value in the tympanites of children and in that of adults during 
typhoid fever. It is also used as a stimulating expectorant in the 
later stages of bronchitis. In nervous irritability of children it is 
often of service. 

Administration. — Asafoetida is given in pills of asafoetida (Pilulce 
(Asafoetidce, U. S.), of which two or three may be taken, each one 
containing 3 grains; the mixture or milk of asafoetida (Mistura Asa- 
foetidce, U. S.), the dose of which is ^ to 1 ounce; and the tincture 
(Tincture Asafostidce, U.S. and B. P.), J to 1 fluidrachm. The sup- 
positories contain what is equal to 40 drops of the tincture ; and the 
plaster of asafoetida (Emplastrum Asafo?tidce, U. S.) is used where a 
faint counter-irritant and antispasmodic is needed. When intestinal 
indigestion and flatulence occurs in old people the following pill is 
of service : 

R • — Ext. nuc. vom . . . gr. v. 

Ext. physostigmaa . .. . gr. iij. 

Asafoetidse . . . gr. xl. 

M. — Ft. in pil. No. xx. S. One night and morning. 

The B. P. preparations not officinal in the U. S. P. are Enema 
Asafoetidce and Pihda Asafostidce Composita, composed of asafoetida, 
galbanum, and myrrh, dose 5 to 15 grains. 



AZEDARACH. 

Azedarach, U. S., is the bark of the Melia Azedarach, or Pride of 
China, as it is sometimes called. It is found in Syria, Persia, and 
the north of India and in the southern United States. 



72 DRUGS. 

The drug has no toxic power, and children may eat it largely 
without ill effect. If very large amounts are used gastro-intestinal 
inflammation occurs. It is employed as a remedy against the round- 
ivorm, and should be given in decoction made by boiling 2 ounces of 
the drug in a pint and a half of water till there only remains a pint of 
liquid. Of this from 1 to 2 tablespoonfuls are to be given a child, 
and repeated every two hours until the bowels are opened. It has 
also been used as a fluid extract prepared by the ordinary means 
with alcohol, to which some white sugar should be added. The dose 
of this is a teaspoonful, not to be repeated. The decoction is the 
best form in which to use the drug. 



BARIUM CHLORIDE. 

One of the most recent and one of the best evidences of the value 
of the study of the action of drugs upon the lower animals is given 
us by this substance. It will be remembered that Brunton and 
Ringer, of London; Kobert and Bary, of Dorpat; and Bartholow 
and the writer in America, have at various times published, during 
the last few years, studies concerning the effect of barium on the 
circulatory apparatus of the frog aud dog, and that all of them 
are in accord in the statement that it slows the heart very greatly, 
steadies its rhythm, and, at the same time, increases the volume of 
blood thrown out of the ventricle. They have also found that 
barium increases blood-pressure, and Kobert has, by a series of 
careful experiments, concluded that it brings about this change by 
an action on the muscular coats of the bloodvessels. 

If large doses are used in the lower animals, the heart suffers 
systolic arrest from over- stimulation, and the strongest irritation of 
the vagus nerves fails to relax the systolic contraction. Still more 
interesting is the statement that this failure of the vagi to inhibit the 
heart is not the result of paralysis of these nerves, but is simply due 
to the excess of cardiac contractile power. The slowing of the pulse 
is not due to inhibitory influence, but depends solely upon the stimu- 
lation of the heart muscle, although it would seem probable that the 
vaso motor stimulation, by increasing the arterial resistance, may be 
at least a factor in the reduction of the pulse-rate. At one time, in 
the dog, after large doses, there is a period of increase of pulse-rate 
which is asserted to be due to stimulation of the accelerator nerves. 

In most works on chemistry barium is stated to be an irritant 
poison, but to produce such evidences of its presence the dose given 
must be extremely large, and many times greater than any amount 
useful for practical medicinal purposes. 

Therapeutics. — Barium chloride may be used in all forms of car- 
diac disease in which failure of the heart muscle is evident. In 



BELLADONNA. 73 

varicose veins it is said to be of value, both when employed internally 
and applied locally over the distended vessels. 

Administration. — The solution to be used internally should have 
the strength of 5 grains to the ounce of water, and of this 1 or 2 tea- 
spoonfuls is to be given three times a day. 

A point worthy of remark is the character of the pulse-wave pro- 
duced. While its volume is increased it does not give that sensation 
of tenseness to the iiuger that does digitalis, and the pulse- wave 
seems to be very considerably prolonged ; a fact that the sphygmo- 
graph also records. 

BELLADONNA. 

Belladonna is botanically known as Atropia Belladonna, and is 
officinal in the form of the root (Belladonnas Radix, U. 8. and B. P.), 
and leaves (Belladonnas Folia, U. 8. and B. P.) It belougs to a very 
large class of plants which all have a similar physiological action. 
Belladonna contains an active principle in the form of an alkaloid, 
known as atropin (Atrophia, U. 8. and B. P.), which is insoluble in 
water. The sulphate of atropin (Atropimv Sulphas, U. 8. and B P.) 
is soluble. 

Physiological Effects. — In man, full medicinal doses produce 
flushing of the face, redness and dryness of the fauces, dilated pupils, 
sometimes an erythematous rash over the skin, rarely diplopia and 
delirium. If the dose be still larger the delirium beconies very 
marked and is wild and talkative. The pulse is rapid and wiry. 
The rash which appears resembles that of scarlet fever, but lacks the 
punctations. The skin may desquamate after several days if the 
rash is severe. 

In children belladonna is usually borne very well indeed, and 
opium very badly. When belladonna asserts itself in children the 
respiration is quickened, the eyes become bright and the cheeks red, 
but lines of pallor reach from the malar bones to the corners of the 
mouth, giving the child a curious expression. 

Xervous System.— Belladonna acts as a powerful excitant of the 
brain and spinal cord. 

When very large doses are given, paralysis of the spinal cord 
comes on, which is followed by tetanic spasms and finally by re- 
covery. The primary loss of power is due to paralysis of the entire 
cord, and the second stage of convulsions to the escape of the motor 
and sensory pathways from the paralysis before the inhibitory centres 
recover. As a result any peripheral irritation causes violent explo- 
sions of motor power. 1 Even in large medicinal dose belladonna 

1 If a homely simile, found useful by the writer in teaching, may be used, the inhibi- 
tory centres may be represented by a schoolmaster, and the motor and sensory centres 



74 DRUGS. 

may be considered as a depressant to the motor nerves and as a 
quieter to the sensory filaments. On voluntary muscles the drug 
has no effect, but upon unstriped muscles it acts as a depressant 
and antispasmodic. It distinctly lessens reflex action. 

Circulation. — Belladonna quickens the pulse by depression of 
the peripheral vagi and by stimulating the cardiac muscle. It pro- 
duces a rise of arterial pressure by stimulating the vaso-motor centre 
and by the increased heart action. In poisonous doses it causes a 
fall of arterial pressure due to vaso-motor palsy, depression of the 
muscular coats of the bloodvessels and to the direct depression of 
the heart muscle. Sometimes when belladonna is given a primary 
but fleeting stage comes on, in which the pulse becomes slow. 

Respiration. — Atropin is a powerful stimulant to the respi- 
ratory centre in ordinary amounts. In large doses it is a depressant 
and paralyzant to respiration, and produces death from respiratory 
failure, due to paralysis of motor nerves supplying the respiratory 
muscles, and probably by depressing the respiratory centres. 

Abdominal Contents. — Belladonna increases peristalsis by de- 
pressing the peripheral ends of the inhibitory fibres of the splanchnic 
nerves and by diminishing any tendency to spasm on the part of the 
muscular coats of the intestine. 

Action of Secretion. — The drug decreases all the secretions of 
the body except the urine, which is sometimes increased in amount 
under its use. The decrease of secretion is due to paralysis of the 
peripheral nerve-filaments supplying the secretory cells of the glands. 

Bodily Heat. — When belladonna is used in large amounts there 
is nearly always a rise of temperature, which in children may amount 
to one or two degrees. In advanced poisoning the temperature 
rapidly falls. 

Elimination. — It is eliminated by the kidneys and bowels and 
is partly destroyed in the liver. In a suspected case of poisoning the 
urine may be dropped in the eye of an animal, and, if atropin has 
been taken, mydriasis will result. 

Eye. — On the eye belladonna produces dilatation of the pupil by 
stimulating the sympathetic fibres of the iris and paralyzing the 
ocular motor fibres peripherally. It generally increases intra-ocular 
tension. 

Therapeutics. — Belladonna is used to allay excessive secretion, to 
act as an antispasmodic, and to influence the circulatory apparatus 
where local inflammations are beginning, particularly in secretory 
glands, and in case of shock and collapse. It is also of practical value 
in neuralgias and the pains due to irritated peripheral nerves. 

To check secretion in night-sweats it is the best remedy we have, 

by two boys. The escape of chloroform in the room paralyzes them all, but, finally, 
the boys recover before their master and go off as truants (convulsions; ; at last the 
master (inhibitory centres) recovers, and order, or health, is restored. 



BELLADONNA. 75 

and it is useful in excessive idiopathic ptyalism, as seen in children, 
or in that due to mercurialization. In bromidrosis of the feet and other 
localized sweatings it is useful. It is the best drug to check the secre- 
tion of milk in an inflamed breast. Belladonna may be used in serous 
diarrhoea, which it checks by stimulation of the splanchnic vaso-motor 
filaments of the intestinal bloodvessels, which being relaxed cause a 
transudation of liquid into the bowel. 

Trousseau recommends as a local remedy the use of 1 to 2 grains 
of the extract of belladonna with 6 to 8 grains of tannic acid in leu- 
corrhoea dependent upon disease of the uterine cervix. This should 
be placed on a pledget of cotton and applied to the affected part 
daily for all day. Ringer states that if pain is also present in these 
cases the following injection is of value : 

]£ . — Sod. bicarbonat gj. 

Tr. belladonnse ^3^- 

Aq. dest. q. s. Oj • 

This is to be injected into the vagina, the woman being placed on her 
back with the buttocks raised before it is used, so that the drug may 
bathe the uterine cervix for some minutes. 

As an antispasmodic atropin is to be used in torticollis, injected 
directly into the muscle itself, so as to act on its motor nerve fibre, and 
it may be given in spasm of the intestine with cramps and griping, while 
in cramps in the legs and body, either as a local application by means 
of liniments, or by its employment internally, it is of service. In 
asthma of the spasmodic type, belladonna is a sovereign remedy, 
particularly if it be combined with morphine. It may be used as a 
prophylactic or as a cure during the attack. 

Belladonna leaves may be smoked by rolling them into a cigar- 
ette or putting them into a pipe. This drug is useful in whooping- 
cough at all ages and in all stages, but has generally to be given in 
large amounts in this disease to do any good. 

In spasm of the sphincter ani, idiopathic or due to fissure, bella- 
donna in an ointment or suppository is of value. In spasm of the 
urethra and bladder the drug may be used internally and externally, 
and in the former state the ointment should be smeared along the 
under surface of the penis every night. This treatment is also 
useful in chordee. In the colic of hepatic and renal calculi belladonna 
in full dose will nearly always give relief. Where urinary incon- 
tinence depends upon spasm of the bladder belladonna should be used 
(see Urinary Incontinence). In dysmenorrhoea in nervous women 
with spasm of the cervix uteri it is of very great value applied 
as an ointment or in a vaginal suppository, or when given by the 
mouth. For the nervous cough of children and adults it is the best 
remedy. In constipation it does good by depressing the inhibitory 
nerves of the intestine. It is also of value in laryngismus stridulus 
and in hiccough. In spasms from peripheral irritations it is of value. 



76 DKUGS. 

In iritis it is to be used to dilate the pupil and prevent adhesions. 
The solution to be dropped into the eye should contain 1 to 4 grains 
of atropin sulphate to the ounce of water. When used to act on 
the circulation it is to be employed in shock and collapse from injury, 
or in the course of severe disease (see Shock). In -pneumonia 
and typhoid fever, or other severe disease, belladonna should be 
kept in the house and pushed freely if collapse or vaso-motor 
relaxation suddenly asserts itself. In mastitis, or inflammation of the 
breast, even where the presence of pus is beginning to show itself, 
belladonna, if pushed, will give surprisingly good results if given 
internally and applied locally. In sore-throat, when the pharynx is 
hot and dry and has a sensation of rawness, while the capillaries 
appear injected and red, belladonna is often of the greatest service in 
full dose, aborting the " cold." In exophthalmic goitre belladonna is 
thought to act by stimulating the sympathetic nerves, and certainly 
gives relief in some cases. In relief of local nerve pains it is of value, 
and acts probably by quieting the irritated nerve. It should be ap- 
plied in these cases in the form of an ointment or plaster and well 
rubbed into the part. 

In headache occurring in young persons, often due to over-work, 
with pain in the eyeballs and forehead and a sensation as if the orbits 
were too small for the eyeballs, belladonna is of service. In inter- 
costal neuralgia or pleurodynia belladonna plasters may be applied 
to the spot with relief. 

Use of Atropin in Poisoning 1 . — Atropin acts as an antidote in 
cases where poisonous mushrooms have been eaten, and is a physio- 
logical antidote to opium, calabar bean or physostigma, and jabo- 
randi. In opium poisoning it acts as an antidote upon all parts of 
the body, and in jaborandi poisoning the same is true. In opium 
poisoning the drug should not be given after the respirations rise to 
ten from three or four per minute, as too much of the drug may be 
given and atropin poisoning may come on. The condition of the 
pupil is not a guide as to the effect of atropin in opium poisoning, 
because opium acts centrically and atropin acts peripherally on the 
nerves governing the iris. Atropin should be used in aconite, anti- 
mony, and hydrocyanic acid poisoning, for its influence on the 
vaso-motor system, the respiratory centre, and the heart, and for the 
purpose of maintaining the bodily heat. 

Administration.-— The dose of the sulphate of atropin (Atrophias 
Sulphas, U.S. and B. P.), is T ^ to -fa of a grain. The alcoholic 
extract (Extractum Belladonnce Alcoholicum, U. S. and B. P.) is 
given in \ to \ grain doses, and the tincture (Tinctura Belladonnce, 
U. S and B. P.) in the dose of 5 to 15 minims. The extract (Ex- 
tractum Belladonnce Fluidum, U. S.) is given in 1 to 2 minim doses, 
while the extract of the B. P. is given in \ to 1 minim doses. Abstrac- 
tum Belladonnce, 17. S., is given in the dose of 1 grain ; Sueeus Bella- 
donnce, B. P., is given in 5 to 15 minim doses. The preparations of 



BENZOIN AND BENZOIC ACID. 77 

the B. P. not officinal in the U. S. P. are Liquor Atropines Sulphatis, 
given in the dose of 1 to 6 minims, Lamellce Atropines, each of which 
contains ^^q- of a grain of atropin, and Unguentum Atropine?. Bel- 
ladonna liniment (IAnimentum Bclladonnce, U. S. and B. P.), Bella- 
donna plaster (Emplastrum Belladonnas, U. 8. and B. P.), and the 
ointment (Unguentum Bclladonnce, V. S. and B. P.) are for external 
application. 

BENZOATE OP BISMUTH. 

This is a preparation which has been highly recommended in 
Germany and to a certain extent in this country within the last few T 
months in the treatment of chancroid. Under its influence the sur- 
face of the sore heals up with great rapidity and leaves a compara- 
tively small cicatrix. It may also be used in the treatment of all 
specific sores and for the dressing of indolent or sloughing ulcers. 
Benzoate of bismuth, when properly applied, should be preceded by 
a careful washing of the diseased surface with a very weak bichloride 
solution, after which the bismuth is to be sprinkled over the wound, 
and the entire surface covered with cotton which should be held in 
place by an adhesive strip. The only disadvantage in this dressing 
lies in the fact that it has to be changed once or twice in every 
twenty-four hours. Immediately after it is applied it may produce 
some tingling or burning, but this is never very severe. 



BENZOIN AND BENZOIC ACID. 

Benzoin (Benzoinum, U. S. and B. P.) is a resinous balsam derived 
from the Styrax Benzoin, which is a native of Sumatra, Borneo, and 
Java. Benzoic acid is obtained by the sublimation of gum benzoin, 
and it is benzoic acid which is generally used in medicine. 

Physiological Action. — Locally applied in concentrated form ben- 
zoic acid is an irritant, and taken internally in excessive amount it 
causes a sensation of warmth and burning. It is eliminated as hip- 
puric acid, and increases the quantity of the acids in the urine. On 
the lower forms of life it acts as an antiseptic and germicide. 

Therapeutics. — Benzoic acid is useful in chronic cystitis with alka- 
line urine which is loaded with phosphates, and, combined with can- 
nabis indica, acts well in the latter stages of gonorrhoea. Senator 
states that in the dose of 2 or 3 drachms a day it is a specific in 
acute rheumatism, and thinks it equal to salicylic acid. When these 
doses are to be used the benzoate of soda should be employed, owing 
to its solubility. In acute laryngitis with great hoarseness the inhala- 
tion of steam laden with compound tincture of benzoin is of the greatest 
service. A tablespoonful of this tincture should be placed in a 



78 DRUGS. 

pitcher of boiling water, and a towel thrown over the head of the 
patient to retain the steam. It cannot be used in an atomizer, as it 
clogs the " tips." Internally it is useful in chronic bronchitis. 

Administration. — The dose of benzoic acid (Acidum Benzoicum, 
U. 8. and B. P.) is usually 10 to 40 grains, but a drachm may be 
given. The gum itself is never used. The tincture (Tinctura 
Benzoini, U. 8.) is given in 30 minim to 1 drachm doses, and the com- 
pound tincture (Tinctura Benzoini Compositce, U. 8. and B. P.) com- 
posed of benzoin, aloes, storax, balsam of Tolu, and alcohol, the dose 
of which is 1 to 2 fluidrachms. The preparations officinal in the 
B. P. but not in the U. 8. P. are the troches (Trochisci Acidi 
Benzoici and Unguentum Cetacei). 

Adeps Benzoinatus ( U. 8. and B. P.), or benzoated lard, is simply 
a non-rancid basis for many ointments, notably that of zinc. 



BICARBONATE OF POTASSIUM. 

Bicarbonate of Potassium (Potassii Bicarbonas, U. 8. and B. P.). 
This salt is used for the same purposes as the citrate and acetate ol 
potassium, and as it is much less agreeable, should not be used 
when they can be obtained. The dose of potassii bicarbonas is 5 to 
40 grains, or even as much as 2 drachms in well diluted water may 
be given. 



BICARBONATE OP SODIUM. 

Bicarbonate of Sodium (Sodii Bicarbonas, U. 8. and B. P.) is a 
salt largely used as an antacid in gastric fermentation, and in 
sick headaches from this cause. Combined with calomel in powder 
it is supposed to add to its efficiency in increasing biliary flow, as all 
alkalies of this class liquefy and thin the bile. The drug has been 
widely employed in the treatment of rheumatism, and is found to be 
of great service to allay pain and soreness in the joints when used 
in the lotion made by dissolving it in water and applying it to the 
part on lint or rags. In acidity of the stomach the following efferves- 
cing powder is useful : Bicarbonate of sodium (Sodii Bicarbonas), 30 
grains in one paper, and, in the other, 20 grains of tartaric acid 
(Acidum Tartaricum). These are each dissolved in half a tumbler 
of water, poured one into the other, and swallowed during efferves- 
cence. 

BITARTRATE OF POTASH. 

Potassii Bitartras, U. 8., Potassii Tartras Acida, B. P. Some- 
times called " cream of tartar," or acid tartrate of potash. It is a 



BISMUTH. 79 

white, gritty powder which may occur in rhombic crystals. Owing 
to its stability it has been thought that it escaped from the body 
without oxidation, aud so to differ from the other potash salts formed 
from vegetable acids. This is probably incorrect. 

Therapeutics. — This is the most diuretic of the potash salts, and 
is used in chronic nephritis with gin or compound infusion of juniper, 
when it is very useful in removing dropsy. One ounce of the salt is 
added to a pint of the infusion of juniper berries, and the entire 
quantity taken in divided doses in twenty-four hours. In acute 
renal disease the drug should be used without the juniper. In 
large doses (half an ounce) it acts as a watery purge, but is rarely 
so used. Where the urine is thick and alkaline bitartrate of potash is 
a useful remedy to render it acid and make it clear and normal in hue. 



BISMUTH. 

Bismuth (Bismuth urn, B. P.) is used in medicine as the subcarbonate 
(Bismuth i Subcarbonas, U. #.), the subnitrate (Bismidhi Subnitras, 
TJ. S. and B. P.), the citrate (Bismidhi Citras, U. S. and B. P.), and 
the bismuth and the ammonium citrate (Bismidhi et Ammonii Citras, 
U. S. and B. P.). The first and second are identical in their dose 
(5 to 20 grains) and action, and may be employed interchangeably. 
The third and fourth are more astringent and more irritating than 
the other two, and must be given in a smaller dose, which is 2 to 
4 grains. Many years ago the drug was supposed to be capable ol 
producing gastro-enteritis in large doses, but this was due to a con- 
tamination by arsenic. Bismuth may produce chronic poisoning after 
prolonged use on wounds or when internally administered. The symp- 
toms under these circumstances are the formation of black sloughs in 
the mouth and gastro-intestinal tract, desquamative nephritis, and 
albuminuria. The preparations of the B. P. not officinal in the 
U. S. P. are the Liquor Bismidhi et Ammonii Citras, dose J to 1 
nuidrachm, and the troches (Trochisci Bismidhi), 2 grains in each. 
Bismidhi Carbonas, B. P., is the same as the subcarbonate of the 
U. S. P. 

Therapeutics. — Bismuth is used as an astringent in large doses to 
cover areas of inflamed mucous membranes and so to allay irritation. 
It is useful in irritative vomiting for this reason, and in diarrhoea of 
a similar type in which the stools are serous. If the passages are 
mucous, castor oil should precede bismuth in order to rid the ali- 
mentary canal of the secretiou already poured out. It is very useful 
when combined with carbolic acid in serous diarrhosa, given in cap- 
sules containing 5 grains of bismuth subnitrate and 1 drop of carbolic 
acid (Wood). It is also to be used as a slow and feeble antacid. 
The Bismuthi et Ammonii Citras is very astringent, and should be 



80 DRUGS. 

used in chronic serous diarrhoeas in the dose of 5 grains every two or 
three hours. The other preparations of bismuth are insoluble, and 
they should not be given in water ; but this preparation is soluble, 
and may be given in solution. The drug is of service in dyspepsia 
where lactic and butyric acid fermentation is present with excessive 
belching, and may be employed in gastrcdgia and gastric ulcer and 
gastritis as a sedative and astringent. The salt of bismuth and am- 
monium citrate must never be employed if acute inflammation exist. 
When the salts of bismuth are used for any length of time they 
cause the odor of garlic in the breath, which is due to an exceedingly 
slight adulteration of the drug with tellurium. The stools are apt 
to become black, and the tongue, if furred, may also be black about 
the centre when bismuth is used. 



BORAX AND BORAOIO ACID. 

Borax, or Sodii Boras ( U. S. and B. P.), is made by the action ot 
boracic or boric acid upon soda. It is soluble in twelve times its 
weight of water. Both borax and boracic acid have been supposed to 
act as efficient germicides in strong solutions, but this has been proved 
incorrect. They are, however, antiseptics even in weak solutions. In 
the form of a lotion boracic acid has been used as a remedy for ery- 
sipelas with a good deal of success, and it may be similarly employed 
in burns and sccdds. Borax may also be used as a wash in diphtheria 
and in aphthous stomatitis, cancrum oris, and gangrenous stomatitis. 
Internally borax has been used in epilepsy, and may be tried with some 
slight hope of a good result. In pruritis ani and vulvce, and in bromi- 
drosis and foetid sweating it is of great value. Strong solutions 
locally applied are useful in tinea tonsurans and tinea circincda. 
Boracic acid may be given internally in cystitis to render the urine 
acid, and is useful in the removal of freckles when applied as a wash 
to the skin. 

It is one of the most commonly used substances in eye washes, 
either alone or with cocaine. 

The following formula may be employed : 

]£. — Cocain. bydrocklor. .... gr. ivtoviij. 

Acid, boracic gr. x to xx. 

Aq. destillat f 3 i j - 

M. — S. To be used in conjunctivitis and similar states. 

Boroglyceride is a solid made by the addition of boracic acid to 
glycerin in the presence of heat. It is soluble in water and 
glycerin. Locally it is used as an antiseptic, and as a vehicle for 
carbolic acid, chrysarobin, and the vegetable alkaloids in skin dis- 
eases and in diseases of the eye, such as purulent ophthalmia. 



BRAYEEA. 81 

The following makes a very elegant application for the skin of 
the face and hands : 

R. — Boracic acid. zj. 



White wax 
Paraffin . 
Almond oil 



3J- 



S. To be thoroughly mixed and applied night and morning. 

Potter recommends the following in uric acid diathesis where there 
is a tendency to the formation of stone : 

R. — Magnesii carbonat. . . . zj. 

Acid, citrici. . . , . :jij. 

Sodii biborat. . . . . spj. 

Aquae bullientis ..... f?viij. 

S. A tablespoonful t. d. 

Or, 

R . — Acid, boracic. . . . . . zj. 

Potas. bitartrat. . . . . % iv. 

Aquse q. s. fjx. 

S. Heat together to dryness, and give 20 grains in water, well diluted, t. d. 

Borated lint is made by dipping lint into a boiling, saturated solu- 
tion of boracic acid or borax. It makes a simple, inexpensive, anti- 
septic surgical dressing, and contains nearly one-half its weight of 
the drug. Glycerinum Boracis, B. P., and Mel Boracis, B. P., are 
not officinal in the U. S. P., but are used as local applications for 
chapped hands and small sores. 



BRAYERA. 

Br ay era, U. S., Cusso, B. P., sometimes called Kousso, is derived 
from Brayera Anihelmintica, a plant of Abyssinia. It contains a vola- 
tile oil, tannic acid, and koosin or taeniin. The drug is used against 
the tapeworm and is most valuable, also possessing the advantage of 
safety. It should be used in an infusion (Infusum Brayerce) in the 
dose of \ an ounce of the powdered flowers to a pint of water, in 
the morning on an empty stomach (see Worms). Koosin may be 
used in the dose of 20 to 40 grains in capsule. The fluid extract 
(Extractum Brayerce Fluidum) is given in the dose of J an ounce. 
It has been said that the drug is apt to cause abortion in pregnant 
women, but this is not known positively as a fact. This drug is 
officinal in the B. P. under the name of Cusso. Infusum Cusso, 
B. P., is given in the dose of 4 to 8 fluidounces. 

6 



82 DRUGS. 



BROMIDES. 

Bromides of potassium, sodium, lithium, calcium, nickel and 
ammonium, and Hydrobromic acid. 

Bromide of Potassium. 

Bromide of potassium (Potasm Bromidum, U. S. and B. P.) is the 
most commonly used and important member of the group first 
named, and will, therefore, be spoken of before the others. 

It is made by the precipitation of freshly made bromide of iron 
by pure carbonate of potassium, or by a process more readily carried 
out and recommended by the B. P. It occurs in colorless trans- 
parent crystals which are stable in dry air, but absorb moisture in a 
damp atmosphere. It is very soluble in water, but less so in alcohol. 
This bromide has a salty taste, and is distinctly irritant to mucous 
membranes if locally applied in concentrated form. 

Physiological Action. — Bromide of potassium has an action upon 
the animal economy which is clearly denned, and closely followed by 
all the other bromide salts, so that what is said here concerning its 
effects may be taken as representing the whole class of bromides, 
except in the instances where slight differences exist, which will be 
pointed out under the various names of the respective salts. 

Nervous System. — The bromide of potash acts as a distinct 
depressant to the motor and intellectual portions of the cortex 
cerebri. It slows the development of thought and decreases the 
excitability and power of the motor cells. (Albertoni.) Upon the 
spinal cord it acts as a marked sedative, affecting chiefly the sensory 
tracts, and causing thereby loss of reflex action and a decrease in 
the ability of the animal to recognize pain. It also depresses to a 
less extent the motor pathways in the cord. Motion is maintained 
after sensations to pain and reflexes are lost. The drug depresses 
the peripheral parts of the sensory nerves, and, in very large doses, 
the motor nerves and muscles are similarly involved. 

Circulation. — If the drug be injected in ordinary dose into the 
jugular vein it causes at once a fall of arterial pressure and pulse- 
rate. These changes are due to a direct action of the bromine aud 
the potassium upon the heart itself. When given to man in thera- 
peutic doses by the mouth its circulatory effect is so slight as not to 
be worthy of consideration. 

Respiration. — Bromide of potassium is a depressant to the respi- 
ratory centre in toxic dose. In medicinal dose it does not affect the 
breathing except where the doses are large and persistently adminis- 
tered, when the breathing becomes slower. 



BROMIDE OF POTASSIUM. 83 

Temperature. — No effect upon this function is noted, unless the 
dose be enormous ; when this is the case the bodily heat is progres- 
sively diminished, and the fall of temperature is probably due to the 
circulatory and nervous depression produced, associated with the 
general failure in vital power. 

Elimination. — The drug escapes very slowly with all the secre- 
tioDS, and is found in the sweat, urine, tears, semen, milk, and 
feces. 

Tissue-waste is decreased. 

Therapeutics. — From what has been already said it is evident that 
bromide of potassium is a remedy to be devoted almost entirely to the 
treatment of diseases of the nervous system, and its uses are there- 
fore as various as the manifestions of perversion of nervous action 
can be various. In a word, it may be said that bromide of potash 
is to be used wherever over-excitement of nervous protoplasm is 
present, but never where nervous symptoms are due to depression. 

In epilepsy, which, to the best of our knowledge, is due to ex- 
plosive impulses arising in the cerebral cortex, it is the best drug we 
have, and in all forms of minor spasm, due to heightened reflex 
activity, it is of service. In spasmodic contractions, for hysterical 
females, in nervous startings and alarm at sudden noises in adults 
and children, and in the nervous symptoms accompanying pregnancy 
and the menopause, it will be found of great value. The following 
prescription is recommended very highly by Goodell, and will be 
found of service in these states : 



R. — Amraon. bromid. 
Potas. bromid. 
Spts. ammon. aromat. 
Aq. camphorse 



• 3>J- 

• 3 1V - 

q. s. ad fgvj. 



M. — S. A dessertspoonful to a tablespoon t'ul every four hours. 

In headaches due to uterine trouble the pain is often felt at the top 
of the skull or at the back of the neck near the occiput. The cause 
of this trouble will often be found to be in the cervix uteri, and alle- 
viation can only be obtained when the uterus is treated and the 
bromides administered. 

In convulsions in children and adults, combined with chloral, bro- 
mides are most efficient, and are sometimes of service in incontinence 
of urine due to vesical spasm. In seminal emissions due to a morbid 
excitability of the centres in the spinal cord, bromide of potassium is 
one of the best remedies we have, and in satyriasis and nymphomania 
it is of great service. 

In cases where undue irritability of the pharynx and larynx pre- 
vents examination of those parts, one or two full doses will render 
an examination easy of performance by decreasing the local reflex 
activity. This is a useful point to be remembered in relation to 
the treatment of pharyngeal and laryngeal disease. 



84 DRUGS. 

The bromides are found to be of service in the laryngeal crises of 
locomotor ataxia, and the explanation of this fact is as follows : The 
adductor centre of the larynx is situated in the brain, and the abductor 
centre in the spinal cord. The first closes the larynx, the second 
opens it, and in health they maintain a patulous tube by their oppo- 
sition. In disease the spinal centre (the abductor or opener) fails, and 
the adductor in the brain being unopposed, produces closure of the 
tube with disastrous results. The bromide, by quieting reflex action, 
as well as the adductor centre in the cerebral cortex, prevents this 
accident. 

In whooping-cough with much mucous exudation the drug is 
rarely of benefit and had better not be used. If laryngismus strid- 
ulus or any form of spasm depending upon local irritation, the 
local trouble must, of course, be removed if possible. In teething 
the drug may be used to decrease the reflex irritation and prevent 
convulsions, and it will decrease the night-screaming of children — 
which is often due to bad dreams — to a very extraordinary degree, 
even if the dose be quite small. As a soporific for the insane, and in 
the insomnia of the overworked and that of nervous women, the bro- 
mide of potassium is of great service. It may also be employed with 
good results in chronic alcoholism and morphiomania. In migraine 
and neuralgia due to eye-strain or other nerve strain, combined with 
caffeine the bromide is almost a specific. The caffeine seems to 
stimulate the depressed nerve up to the normal level, and the bro- 
mide to deaden the perception of the pain. The following is a most 
valuable remedy in migraine and even in sick headache. It ought 
not to be used in bilious headache, which will be made worse by it : 

$ . — Antipyrine ........ gr. xxv. 

Caffein. citrat. . . . . . . gr. x. 

Potas. bromid. gr. xxv. 

Acid, phosphoric ....... gr. xxv. 

M. — Ft. in chart No. v. S. One powder as needed. 

In dysmenorrhea and menorrhagia, particularly in young subjects, 
the bromides are also of service (see Dr. Goodell's prescription, p. 83). 
When the flow is too great at such a period the drug should be begun 
a week before the expected epoch, and kept up in the dose of 5 to 10 
grains night and morning. In cases where the epochs follow one 
another too closely the drug should be used continuously. After an 
apparent cure ensues the drug should be used for a few periods to 
avoid a relapse. In sea-sickness the bromides are the best prophy- 
lactics we possess, and should be used in the dose of 5 to 10 grains 
three times a day for several days before sailing in order to quiet the 
vomiting centre. After sea-sickness begins they should not be given 
in ordinary solutions but in an effervescing draught made as follows: 

R. — Acid, citric. . . . . . • . . gij. 

Aq. dest. . f ^iv. 

M.— Ft. sol. 



BROMIDE OF AMMONIUM. 85 

R. — Potas. brom 3j. 

Potas. bicarb. . . . . . . zj. 

Aq. dest. . . . . . . . . . f Jiv. 

M. — Fl. sol. A tablespoonful of each of these solutions should be added to one 
another and taken during effervescence. 

This prescription will also be found of value in the persistent 
vomiting of pregnancy and in that following prolonged etherization, 
or other states. If the vomiting is excessive the dose ought to be 
reduced to 2 teaspoon fu Is of each solution and be given every half- 
hour until half of each mixture is taken or the patient relieved. In 
cases where this will not act rectal injections of the following will be 
found of value : 

R • — Potas. brom. ........ gr. xxx. 

Tinct. opii deodorat. . . . . . . gtt. xxx. 

Aq. amyli f 3 v j- 

M. — S. To be injected gently into the empty rectum and retained as long as 
possible. 

This method is the most reliable plan that can be followed. 

Bromide of potassium may be used to prevent the symptoms o± 
cinchonism after quinine aud salicylic acid, and it is said to prevent 
the nausea aud depression so apt to follow the use of opium. 

Administration. — The dose of bromide of potash is from 5 to 60 
grains a day. 

Use of Bromides in Poisoning. — Bromides are useful in all con- 
vulsive attacks consequent upon the ingestion of poisons, except those 
due to cardiac sedatives which alter the circulation at the base of the 
brain, and may be used to allay any nervous symptoms which are of 
an excited nature, to prevent excessive vomiting, to produce sleep, 
and to quiet delirium. 

Effects of Prolonged Use. — After the drug has been used for some 
time acne appears about the face and extends over the entire body, 
the breath becomes foetid, the patient dull, expressionless, and heavy, 
remaining buried in sleep for nearly every hour of the day. Duriug 
this time he can be aroused, but at once falls to sleep again. The 
walk becomes weak and feeble, the movements slow and painfully 
prolonged. Taste is lost and hearing is benumbed, while the brain 
is almost blank. Loss of sexual power is an early symptom. The 
acne may be put aside by the use of arsenic ; where bromides are 
used to any extent in women this drug should always be given simul- 
taneously to prevent the eruption. As Fowler's solution is compati- 
ble with the bromide in solution, it is the best form of arsenic to 
employ. 

Bromide of Ammonium. 

Bromide of Ammonium (Ammonii Bromidum, U. S. and B. P.). 
This salt is far more stimulating than the bromide of potassium, 



86 DRUGS. 

and it is certainly much more irritating. The dose is the same as the 
potash salt — 5 to 60 grains a day. Da Costa has recommended it 
highly in rheumatism in large doses well diluted. 



Bromide of Calcium. 

Calcium Bromide (Calcii Bromidum, U. 8.) was introduced into 
medicine as a nervous sedative and hypnotic, and was thought at one 
time to be an efficient substitute for the bromide of potassium. Its 
action on the nervous system is virtually identical with that of the 
potash salt, and it has been found to be far less irritant and depres- 
sant than the latter. For some unknown reason it has never won 
the confidence of the profession, but it may be given with very good 
results in the dose of from 30 to 90 grains a day, or even more in 
cases which are not readily affected by bromides. It is employed 
especially in hysteria and epilepsy, and in all the conditions in which 
the other bromide salts are indicated. It is sometimes of value com- 
bined with the potash salt, since under such circumstances better 
results are often gained than if one drug alone is employed. 



Bromide of Lithium. 

Bromide of Lithium (IAihii Bromidum, U. 8.). This is much 
weaker than the other salts, and may be given in larger dose. Dr. 
S. Weir Mitchell states that it is of value in epilepsy after the potash 
salt fails. The dose is 30 to 90 grains a day. 



Bromide of Nickel. 

This is a green salt quite irritant to the stomach. It should be 
given well diluted, or in an effervescing draught, as it is apt to 
disorder the stomach if used in concentrated form. 



Bromide of Sodium. 

Bromide of Sodium (Sodii Bromidum, U. 8. and B. P.). This salt 
is to be used in every instance where bromide of potassium can be 
employed. Its dose is the same, although it is asserted to be a little 
weaker physiologically, grain for grain, than the potash salt. It is 
far less apt to disorder the stomach, and is not so generally depres- 
sant as is the bromide of potassium. 



BUCHU. 87 



Hydrobromic Acid. 

Hydrobromic Acid is an extremely irritant preparation, but is 
thought to be less apt to cause acne and other untoward effects than 
the other bromides. It is only to be used in the form of the officinal 
dilute acid (Acidum Hydrobromicum Dilutum, U. S. and B. P.), and to 
be given in the dose of from one drachm to half an ounce well diluted 
with sweetened water. It is highly recommended for headaches due 
to eye-strain in nervous women by De Schweinitz and others. 



BROMINE. 

Bromine (U. S. and B. P.) is a dark-red liquid of an excessively 
pungent odor like that of chlorine, and possesses very extraordinary 
power as a caustic when applied to the tissues of the body. It is the 
most severe caustic we possess, and penetrates very deeply. It should 
be applied in hospital gangrene and other large sloughs, by means ol 
a glass rod. 

BUCHU. 

Buchu ( U. S.) is derived from Barosma Betulina, a plant of Africa, 
and contains a volatile oil, which is probably the active principle, 
and a bitter extractive. It is officinal, under the name of Buchu 
Folia, in the B. P. 

Therapeutics. — Buchu is used as a diuretic when it is desired to 
affect the mucous membranes of the genito-urinary tract which are 
chronically diseased, and particularly when these parts are below 
their normal tone. It does not increase the urinary flow to any 
great extent, but acts on the genito-urinary passages. It is useful in 
pyelitis, cystitis, and vesiccd irritation of the chronic type. If the urine 
is highly acid, muddy, laden with salts, and productive of inconti- 
nence by reason of irritation, buchu in the form of the fluid extract, 
in the dose of a teaspoonful three times a day combined with an equal 
amount of sweet spirit of nitre, will be of great service. For a child 
the dose should be about ten to thirty minims. If the vesical irrita- 
tion is acute buchu is contra-indicated. 

Administration. — The fluid extract (Extractum Buchu Fluidum, 
U. 8.) is the only preparation officinal, and should be always well 
diluted before it is given, in the dose, to an adult, of 1 drachm three 
times a clay. The infusion is not officinal, and is made by adding 
one ounce of leaves to a pint of water. The dose of this is a table- 
spoonful to two tablespoon fuls. The officinal B. P. preparations are 
the infusion (Infusum Buchu), dose 1 to 4 fluidounces, and the tinc- 
ture (Tinctura Buchu), dose 1 to 2 fluidrachms. 



DRUGS 



CAFFEIN. 



Caffein (Cafeina, U.S. and B. P.) is an alkaloid derived from 
the berries of Qaffea Arabica, which also contain, upon roasting, an 
empyreumatic oil. Caffein is usually employed in medicine as the 
citrate, and is soluble in 75 parts of water. 1 

Physiological Action. — On the nervous system caffein acts as a 
stimulant of a rapidly acting nature exerting its chief influence on the 
brain and spinal cord. By its cerebral effect it causes increased 
rapidity of thought, and by its influence on the spinal cord it increases 
reflex activity, and for this reason is said to make people "nervous." 
It is important to remember that it has no effect on brain protoplasm 
except to stimulate it, and that ultimately a brain driven along by 
caffein breaks down by the concentration of its energy for the time 
being in one effort. In poisonous doses it causes tetanic convulsions 
in the frog by an action on the spinal cord, and if applied directly to 
a muscle, causes it to contract spastically. It does not affect the 
motor nerves. 

Circulation. — Caffein augments the pulse-rate and blood- 
pressure by stimulating the heart muscle, but sometimes causes a 
decrease in arterial pressure. Clinically it certainly seems to raise 
the blood-pressure in almost every instance where it is used. 

Kidneys, Tissue- waste, and Elimination. — Caffein increases 
diuresis by a direct stimulation of the secretory epithelium of the 
kidney, and therefore increases the amount of solids as well as ot 
the liquids in the urine. Upon tissue-waste the drug evidently acts 
as a depressant, and is therefore a conservator of the tissues. It is 
burnt up in the body. 

The empyreumatic oil, of which there is about one teaspoonful in 
each well-made breakfast cup of coffee, has physiological effects some- 
what different from those of caffein (Marshall and Hare). It is 
probably the cause of the "biliousness" sometimes produced by 
coffee, due to the faulty digestion of this oil, which is apt to disorder 
the digestion when taken alone. 

Therapeutics — Caffein is a valuable cardiac stimulant and tonic 
as well as a renal stimulant. It acts equally well in cardiac and 
renal dropsies for this reason, and is an invaluable remedy in such 
cases. In acute Bright's disease it is contra-indicated, because all 
stimulants are contra-indicated in acute inflammations. In opium 
poisoning, owing to its stimulant effect on the respiratory centre, it is 
very valuable, and it may then be given in the form of strong black 
coffee, and will aid in keeping the patient awake and also add heat 

1 Thein, derived from tea, caffein, the active principle of coffee, and the alkaloid or 
quarana from South America, are chemically identical. Much of the caffein of com- 
merce is really thein, although it is claimed that pure thein has a very different phy- 
siological action. 



CALCIUM. by 

to the body, which is often lacking. A cup of strong black coffee 
is often useful in a paroxysm of asthma. In headache due to nerve- 
strain, caffein combined with antipyrine and one of the bromides is 
of the greatest service (see Neuralgia). So useful is it in cardiac disease 
as to have largely supplanted digitalis in the hands of some practi- 
tioners. 

Caffeince Citras, U. S. and B. P., cannot be used hypodermieally, 
owing to its decomposition in the presence of water. The following 
may, however, be used hypodermically : Salicylate of soda, 30 parts ; 
caffein, 40 parts ; and distilled water, 60 parts. 



OIL OF OAJUPUT. 

Oil of Cajuput {Oleum Cajuputi, U. 8. and B. P.) is a volatile oil 
distilled from Melaleuca Cajuputi, a tree of the Molucca Islands. It 
is a stimulant, and in large amounts an irritant, to mucous mem- 
branes, and acts as an efficient carminative and parasiticide. As a 
remedy for tinea tonsurans and pediculi it should be applied pure to 
the part affected. It is capable of irritating the skin. In diarrhoea 
of a serous type it is of value in the dose of 10 to 20 drops (see 
Diarrhoea). Spiritus Cajuputi is officinal in the B. P. ; dose, J to 
1 fluidrachm. 



CALCIUM. 

Calcium is officinal in a number of forms, and is to be distinctly 
separated in the mind of the student from calx or lime, which is an 
oxide of calcium. It is never employed as calcium, but as one of its 
salts. These are as follows : Bromide of calcium (Calcii Bromidum, 
U. S.), precipitated carbonate of calcium ( Calcii Carbonas Precipitatus, 
U. S., Calcii Carbonas Precipitata, B. P.), chloride of calcium [Calcii 
Chloridum, U. S. and B. P.), hypophosphite of calcium (Calcii Hypo- 
phosphis, U. S. and B. P.), and as precipitated phosphate of calcium 
(Calcii Phosphas Precipitatus, U. S., Calcii Phosphas Precipitata, 
B. P.). 

All salts of calcium are incompatible with acids. Calcium sul- 
phate is not officinal. The precipitated carbonate of calcium is used 
in the treatment of serous diarrhoea, and as an antacid and as a local 
protective in cases of chapped skin or intertrigo, particularly in young 
children. When given internally the dose is from 10 to 30 grains, 
but by far the best method for its administration is in the employ- 
ment of chalk mixture ( Ifistura Greta, U. S. and B. P.), which con- 
tains about 30 grains of the chalk to each ounce of liquid. The dose 
of this mixture is from a teaspoonful for a young child to an ounce 



90 DRUGS. 

for an adult. Id cases of diarrhoea it is best given in combination 
with tincture of kino or the compound tincture of catechu and 
paregoric, in some such form as follows : 

R..— Tr. kino fgj. 

Tr. catechu comp. . . . fgij. 

Misturae cretse . . . q. s. fjvj. 
M. — S. A. dessertspoonful every three hours till diarrhoea ceases. 

It is to be remembered that the chalk mixture acts very slightly 
as an astringent, and chiefly as an antacid and mechanical agent in 
the alimentary canal. 

Precipitated carbonate of calcium is the slowest antacid which we 
possess, and for this reason is the remedy to be employed in acidity 
of the intestines, as it passes through the stomach to a very great 
extent unchanged. (For the varieties of diarrhoea in which it is to 
be used see article on Diarrhoea.) As an external application it is 
used in sweating of the feet and hands, and sometimes as a dry 
dressing to ulcers. It may also be used over burns. 

Calcium chloride, when taken internally in any amount, acts as an 
intense gastro-intestinal irritant, and may produce death by this 
means. It is to be distinctly separated from the chlorinate or chlo- 
ride of lime, with which it is sometimes confused, for the latter is 
nothing more than hydrate of lime or slaked lime, containing 25 per 
cent, of chlorine, while chloride of calcium is a hard, vitreous, friable 
substance, giving off no odor of chlorine and utterly different in its 
use, action, and appearance. 

Chloride of calcium is used in medicine by some physicians in 
scrofulous enlargements of glands in the neck and elsewhere, and is even 
said to cause calcification and encysting of tubercular nodules. In 
cases where deficient bone formation is evident it often does good, but 
the other salts of lime, such as the hypophosphates, are better. In 
cases where boils mature slowly a poultice made by adding a solution 
of chloride of lime to the mass may be used to hasten suppuration. 
The dose is 5 to 30 grains, best given in a solution made by adding 
water in the proportion of 1 drachm to each 5 grains of the drug. 

The hypophosphite of calcium and the precipitated phosphate of 
calcium are used for the same purposes, generally in the form of 
the Syrupus Hypophosphitum, U. S., and the Syrupus Calcii Lacto- 
phosphatis, U. S. 

The large amount of phosphate of calcium in the bones and tissues 
renders it a useful drug where the tissues are starved of their proper 
proportions of salts, and its use has been found, in animals, to cause 
a great increase in bony growth, not only in the earthy but also in 
the animal constituents of the osseous tissues. The hypophosphite 
has a similar effect. 

In rickets and in fractures where the bone is slow in uniting, and 
in some cases of phthisis and scrofula, the lactophosphates and hypo- 



C ALU MB A. yi 

phosphites are of service. In dental caries, particularly that occur- 
ring in uursing women, and in the anaemias of this class of patients, 
they are useful. In general debility and nervous prostration they are 
often of great value, and may even be used with benefit in chronic 
and atonic diseases of the skin and mucous membranes. In cases 
of hepatic torpor they may be used with advantage. 

The lactophosphates are better than the hypophosphites, as the 
latter are probably changed into phosphates in the stomach as soon 
as they enter this viscus. The only advantage which they possess over 
phosphorus itself is that they afford an easy method of administra- 
tion, and also that they contain calcium. The dose of either of the 
two drugs is 10 to 30 grains three times a day, or, of the syrups just 
named, a teaspoonful to a tablespoonful. 

Sulphate of calcium is not to be confounded with sulphide of cal- 
cium. The latter remedy, which was first used by Sidney Ringer, is 
a very useful preparation in the treatment of boils, both as a remedy 
to hurry on the " pointing " of the boil and to prevent the formation of 
others. The dose of calcium sulphide or calx sulphurata is y 1 -^ grain. 

Prepared chalk (Creta Preparcda, TJ. S. and B. P.) is given in the 
dose of 20 to 60 grains. Other preparations are compound chalk 
powder (Pulms Creke Compositus, U. S.), dose 10 to 60 grains, 
troches of chalk (Trochisci Creke, U. 8.). Preparations officinal in 
the B. P., but not in the U. S. P., are aromatic powder of chalk 
(Ptdvis Creke Aromcdicus), dose 10 to 60 grains, (Pulvis Creke 
Aromaticus cum Opii), dose 10 to 60 grains. 



CALUMBA. 



Calumba, Columbo, or Columba, is the root of the Cocculus Pal- 
matus, a climbing plant of Mozambique. Its taste is bitter, and its 
odor is slightly aromatic. Two alkaloids are found in it, berberin 
and columbin, and a third substance known as columbic acid. 
Calumba is one of the purest bitters known. 

Therapeutics. — This is one of the best simple tonics which can be 
used, owing to its lack of astringent effect and to its favorable action 
oil mucous membranes. 

In cases of gastro- intestinal atony, particularly that following fevers 
and similar states, calumba will be found of service, and it is a valu- 
able remedy in the convalescent stages of summer complaint and serous 
diarrhoeas. The following prescription of Dr. George B. Wood is 
very useful in these states when they are associated with flatulence : 

R . — Calumbae pulv ^ss. 

Zingiber, pulv. . . . ^ss. 

ISennse fol. ..... £j. 

Aq. bullientis .... 6j. 

M. — Ft. in infusio. S. A winegla?sful t. d. 



92 DRUGS. 

Administration. — The fluid extract (Extractum Calumbce Fluidum, 
U. S.) is given in the dose of 15 to 60 minims ; the tincture (Tinctura 
Calumbce, U.S.), dose 1 to 4 fluidrachms. The dose of the extract 
(Extractum Calumbce, B. P.) is 2 to 10 grains ; the infusion (Infusum 
Calumbce, B. P.) 1 to 2 fluidounces, and the tincture {Tinctura 
Calumbce, B. P.) J to 2 fluidrachms. 



CALX. 

Calx, or lime, or oxide of calcium, is an alkaline earth which is 
incompatible with acids, ammoniacal and metallic bases, borates, 
alkaline carbonates, and astringent vegetable infusions. 

Therapeutics. — Lime is used for the purpose of acting as an 
escharotic, particularly on old ulcers and on hairy growths It is 
never giveu internally, except in the form of the hydrate or slaked 
lime. As an escharotic application lime is used in the officinal 
caustic Potassa cum Calce. When given internally it should always 
be used as Liquor Calcis (U.S. and B. P.) or lime-water, and under 
these circumstances it acts as an antacid, as an aid to the digestion of 
milk by preventing too rapid and solid coagulation of the casein, 
and by exciting an increased gastric secretion. It is also feebly 
astringent. Given to infants and nursing women it is probably 
utilized in the body in the formation of bone. It is also of value 
in diabetes, in the uric acid diathesis, and in the excessive nausea 
and vomiting very often seen in adults and children. Teaspoonful 
doses of milk and lime-water, equal parts, will often be retained 
when nothing else will remain in the stomach. 

The dose of lime-water is a teaspoonful to 1 ounce or even 2 
ounces. Externally applied lime-water is of value in tinea capitis 
and similar states, and it is the best application in burns, w T hen it is 
to be mixed with equal parts of linseed or olive oil, forming the 
Linimentum Calcis, U S. and B. P., or carron oil. As a local appli- 
cation in membranous croup and diphtheria lime-water has a high 
reputation and is believed to dissolve the membrane. It may be 
used as a spray or by means of a swab. 

Liquor Calcis or lime-water is to be made by adding a piece of 
unslaked lime as large as a walnut to 2 quarts of boiled and filtered 
water in an eartheu jar ; after stirring it thoroughly allow it to settle, 
and pour off the clear liquid into a bottle. More water may then be 
added to the lime until it is all used. 

Sulphurated lime (Calx Sulphurata, U. S. and B. P.), useful to 
check inflammation and hasten suppuration ; the dose is -^ of a grain. 
The preparations of the B. P. that are not officinal in the U. S. are 
the saccharated solution of lime (Liquor Calcis Saccharatus), dose 15 
to 60 minims, and slaked lime (Calcii Hydras) used in different 
preparations. 



CAMPHOR. 93 



CAMPHOR. 



Camphor (Camphora, U. 8. and B. P.) is derived from the Oin- 
nomomum or Taurus Camphora, which grows chiefly in China and 
Japan. The camphor used in the drug stores is in reality refined 
camphor, and is so obtained by repeated sublimation. It is a vola- 
tile, irritant gum or resin, producing a burning taste and possessing 
a peculiar odor, soluble in one thousand parts of cold water and in 
one part of strong alcohol. Camphor is so volatile that if allowed 
to remain exposed to the air for any time it rapidly loses its bulk 
and eventually disappears. It is an exceedingly combustible sub- 
stance, burning with a flame and much smoke. It may be white or 
pinkish in color. 

Physiological Action. — If taken in large amount camphor pro- 
duces epileptiform convulsions preceded by vertigo, roaring in the 
ears, and delirium, The pulse soon becomes rapid, feeble, and run- 
ning, and the skin livid, cold, and covered with sweat. Great heat 
and burning may be felt in the belly, and if the poisoning be slow, 
evidences of gastro-intestinal and renal inflammation ensue. In 
small doses it acts as a stimulant and adds a sensation of warmth to 
the stomach, while the pulse may become more rapid and stronger 
under its influence. At the same time there is a sedation of the 
nervous system and a general feeling of contentment. In large 
medicinal dose camphor is thought by some to act as a sexual stimu- 
lant and by others as a sexual sedative. The stimulant effect is 
probably only due to doses large enough to produce irritation of the 
genito-urinary tract. The convulsions following poisonous doses are 
cerebral in origin, and the drug, although greatly broken up in the 
body, is eliminated by the kidneys as campho-glycuric acid and 
escapes by the breath and perspiration. 

Therapeutics. Internal Use. — Camphor is employed for the 
purpose of acting as a nervous sedative and antispasmodic in nervous 
women and children, and as a carminative in persons who suffer from 
intestinal flatulence. It is of value in nervous dysmenorrhea and 
headache, and is best combined with one of the new analgesics, such as 
antipyrine and antifebrin given in pill form. As it is virtually a 
volatile oil, so far as its physiological action is concerned, it will be 
found useful in cholera morbus and all forms of serous diarrhwa, 
but never in mucous diarrhoea (see Diarrhoea). In chordee, com- 
bined with bromides and similar depressants to the spinal cord, 
camphor is of great service in some cases, particularly late in the 
disease. In adynamic fevers it has been used as a diffusible stimulant 
by Graves and others with great success. In hiccough it is of great 
service, and in cardiac palpitation due to functional irritability it is 
found of value. In capillary bronchitis and catarrh of the air- 



94 DRUGS. 

passages it will be found of service in old or atonic cases. It is also 
of value as a mouth-wash in persons who have foetid breath. 

External Use. — Externally camphor may be used as a stimu- 
lant to indolent sores, and as a useful addition in small amount to the 
precipitated carbonate of calcium as a dusting powder in intertrigo. 
In the form of a liniment camphor is used over inflamed joints from 
sprains or rheumatism, and in myalgia and neuralgia to relieve the 
pain and stiffness. 

Camphor may be inhaled or taken internally in cases of cold in 
the head with great relief and a decided influence in aborting the 
attack. After the attack is in full force it is useless, but used early 
it will decrease the frontal headache and the sneezing and running at 
the nose. In coryza from unknown causes with much lachrymation 
and incessant sneezing, camphor will be found of benefit. It may 
be snuffed up the nostril in a fine powder or put in boiling water 
and the fumes inhaled. The spirit may also be inhaled from a hand- 
kerchief. 

Camphorated alcohol, spirit' of camphor, is a useful abortive appli- 
cation over boils, in their formative stage, two or three times a day, 
for a few moments at a time. Following these applications the skin 
should be dried and camphorated oil be applied. Ringer and Tilt 
both recommend Eau de Cologne saturated with camphor rubbed into 
the head in the drowsiness and headache of the menopause, and a 
lotion of equal parts of aqua ammonia and spirit of camphor dabbed 
on the painful spots of hyperesthesia at the top of the head so com- 
monly felt at the change of life or during menstruation. 

Administration. — Camphor is used internally in the form of the 
camphor water {Aqua Camphor m, U. S. and B. P.), dose, J to 2 
fluidounces ; the spirit of camphor (Spiritus Camphorm, U. S. and 
B. P.), dose, J a fluidrachm, or in the form of the camphor itself, in 
pill, in the dose of 1 to 3 grains in each pill. The best preparation 
for internal use is the spirit, or the camphor in pill form. 

For external use we have officinal the Camphor Liniment (Lini- 
mentum Camphorce, U. S. and B. P.), and the Soap Liniment, or 
Linimentum Saponis, U. S. and B. P., which is the mildest of the 
two. Oeratum Camphorce is also officinal. A compound tincture ot 
camphor (Tinctura Camphorce Composita), composed of opium, ben- 
zoic acid, camphor, and oil of anise, is officinal in the P. P., dose, 15 
minims to 1 fluidrachm. Linimentum Camphorce Composition, B. P., 
is composed of camphor, rectified spirit, and stronger ammonia. 



CAMPHOR MONOBROMATE. 

Monobromate of Camphor (Oamphora Monobromata, U. S.). This 
drug is made by heating together in a sealed tube camphor and bro- 
mine. It occurs in colorless crystals or scales, and has a mild taste 



CANNABIS INDICA. 95 

resembling camphor. It is almost entirely insoluble in water, but 
freely soluble in alcohol, ether, and chloroform. 

Physiological Action. — It possesses powers partaking of the 
bromides and of camphor. In the frog it causes loss of reflex action 
and motor palsy and death by respiratory failure, and in warm- 
blooded animals violent convulsions, Cheyne-Stokes respirations, 
muscular tremblings and weakness come on. The pulse is at first 
more rapid than normal, then slow and weak, and death comes in 
coma or in the convulsions. 

Therapeutics. — Monobromated camphor will generally be found 
most useful in combination with other drugs in pain, such as lum- 
bago or that due to nervous disturbances. If used in hysterical 
females it will often produce sleep, and is of value to those who are 
addicted to the camphor-habit, as it acts as a hypnotic and warms 
the stomach. Like camphor itself, it is a gastric irritant, and should 
not be employed where gastritis exists. It has been used in sperma- 
torrhea with great success, and in delirium tremens has been found 
of benefit in cases where the gastric mucous membrane is depressed 
and the nervous twitchings are troublesome. In ichooping-cough it 
may be tried, and has even been used in chorea, epilepsy, and 
petit mat. 

Administration. — It should never be used hypodermically as it is 
too irritating, but administered 5 grains t. d. in pill or in an emul- 
sion made by dissolving it in six times its weight of expressed oil of 
almonds and then forming an emulsion with gum arabic and water 
in the usual manner. 

CAMPHORIC ACID. 

Camphoric Acid is made by the oxidation of camphor through the 
influence of acids, and has been used in the night-sweats of phthisis 
with considerable success. Whether it is sufficiently valuable to 
obtain a permanent place in the treatment of this troublesome con- 
dition we do not know, as it has not been tried for a long enough 
period to render a decision possible. 

In cases where ordinary remedies fail it may be resorted to in the 
dose of from 20 to 30 grains taken an hour or two before the 
sweat is expected. In very obstinate cases as much as 60 grains 
should be given, but in these cases it should be used in two separate 
doses of 30 grains each, two hours apart, in order to avoid irritat- 
ing the stomach. It is best given in capsule. 



CANNABIS INDICA. 

Indian Hemp {Cannabis Indica, U. S. and B. P.). Cannabis 
Indica and Americana are the two forms in which this drug appears, 



96 DRUGS. 

but it is only the Cannabis Indica which is generally used in medi- 
cine. They are to be distinctly separated from American, Indian 
or Canada hemp, which is Apocynum Cannabinum, and which is an 
intense irritant and drastic. 

Physiological Action. — In full dose to man this drug causes ex- 
hilaration, and periods of constant laughter at the slightest cause, 
the person seeming convulsed with merriment ; in other cases the 
sensations are disagreeable, and even death may seem imminent to 
the deranged mind. Often the sensation of very full breathing 
comes on, and the patient thinks he is about to burst with the infla- 
tion of his lungs. After this deep sleep appears, lastiug for many 
hours, even as much as fourteen or fifteen, without any awaken- 
ing. If the dose be very large the respirations are slowed very 
considerably, but no case of death from its use in man is on record, 
and enormous amounts have been given to the lower animals with- 
out causing a lethal effect. 1 Locally applied it acts as a very severe 
irritant and then as a local anaesthetic, but the primary effect is so 
powerful as to prevent its use locally in pain. 

One of the most constant and pressing symptoms in poisoning in 
man is the marked sensation of prolongation of time so that min- 
utes seem like hours, and, in addition to this, a peculiar separation 
of the mental powers during which both hemispheres of the brain 
seem to think differently on the same subject. 

Therapeutics. — Cannabis indica is one of the best adjuncts to 
cough mixtures that we possess, as it quiets the tickling in the throat 
and yet does not constipate or depress as does morphine. In 
advanced phthisis it is justifiable to keep the patient constantly in a 
state of euthanasia by its use. For the relief of pain, particularly 
that depending on nerve disturbance, it is very valuable. Before 
the introduction of antipyrine and its congeners, tincture of gelsem- 
ium and the tincture or extract of cannabis indica were our best 
remedies in migraine. The gelsemium should be given in full dose, 
20 drops of the tincture, and be followed by 10 to 20 of the fluid 
extract of cannabis indica. In true migraine with hemianopsia this 
treatment is often most effectual in aborting the attack. The pre- 
vention of further attacks is to be attained by the use of smaller 
amounts of the cannabis indica during the intervals; the gelsemium 
being only used at the onset of the symptoms. In paralysis agitans 
cannabis indica may be used to quiet the tremors, and in spasm of the 
bladder, due to cystitis or nervousness, it often gives great relief. 
In impotence, not dependent upon organic disease, it is said to be of 
value combined with strychnine, or nux vomica, or ergot. 

In headaches at the menopause cannabis indica is useful, and, if 
the headaches are associated with constipation, iron and aloes should 

1 The author has injected as much as 5 drachms of a fluid extract, active in the dose 
of 10 minims to man, into the jugular vein of a small dog without producing death for 
many hours. 



CANTHAKIS. 97 

be given simultaneously, particularly if anaemia is present. In 
whooping-cough and asthma it sometimes proves of service. 

In uterine subinvolution, chronic inflammation and irritation cannabis 
inclica is of great value, and has been found of service in metror- 
rhagia and nervous and spasmodic dysmenorrhea. Not only does it 
relieve the pain, but seems to act well on the muscular fibres of the 
uterus. 

In acute and chronic Bright' s disease cannabis indica often allays 
the painful sensations over the renal region, and has been recom- 
mended by some writers in the cases where bloody urine is present. 
In gonorrhoea it is said to decrease the discharge and prevent chordee, 
and has supplanted the use of copaiba and cubebs in some practi- 
tioners 7 bauds. It should not be used in the early stages of gonor- 
rhoea, but in the subacute stage. 

There is some foundation for the belief that small doses act as a 
sexual stimulant. The advantages possessed by it are its lack of 
constipative power, its freedom from after-depression and nausea, 
its happy effect in some cases, and an increase rather than a decrease 
of the appetite. 

Administration. — The employment of this most valuable remedy 
is handicapped by its frequent lack of power — a fault which is largely 
dependent upon its preparation. That prepared by Parke, Davis & 
Company and the solid extract of McKesson & Robbins have proved 
efficacious in my hands for a number of years. The physician should 
always employ some preparation known by him to be active by 
personal trial before condemning the drug as a failure in a given case. 

The dose of the solid extract (JExtractum Cannabis Indicce, U. S. 
and B. P) is from ^ to J grain, that of the fluid extract (JExtractum 
Cannabis Indicce Fluidum, U. 8.) from 4 to 20 minims, and that of 
the tincture (Tinctura Cannabis Indicce, U. S. and B. P.) from 15 
minims to 1 drachm. 



CANTHARIS. 

Cantharis (U. S. and B. P.), or "Spanish Fly," is really a beetle 
known as the cantharis vesicatoria, and as such appears with an iri- 
descent covering or wing-sheaths of a bluish or greenish hue. They 
come chiefly from Spain, Italy and Sicily, and from the southern 
parts of Russia. Those from Russia are supposed to be the best. 
According to Leidy, the vesicating substance is in the blood, the 
eggs, and the secretions of the generative apparatus. This substance 
contains cantharidin as an active principle, but cantharidin is not 
medicinally employed. 

Physiological Action. — The ingestion of a moderate dose of can- 
tharides only produces slight stimulation of the genito-urinary system, 

7 



98 DRUGS. 

particularly the kidneys and urinary tracts. Large amounts produce 
great pain in the lumbar region, burning in the entire bladder and 
urethra, priapism, agonizing vesical tenesmus, widespread acute 
nephritis, bloody urine, which is scanty and finally suppressed, and 
great irritation of the external openings of the genito-urinary appa- 
ratus. The inflammatory changes may cause sloughing of the penis 
or of the labia? in the female. 

Violent gastro-enteritis is nearly always a pressing condition. 
The drug has no true aphrodisiac influence except in toxic dose. A 
diagnostic sign of cantharidal poisoning, where the beetles have 
been swallowed, is the iridescent pieces of the wings and coats which 
appear in the vomit. Thirst is always a prominent symptom. 

Therapeutics. — Cantharides are employed internally and exter- 
nally. When given by the mouth the tincture is used as a uterine 
stimulant to affect the uterine mucous membrane aud relieve amenor- 
rhea in cases where atony and depression are the cause of the sup- 
pression. Some persons teach that the tincture of cantharides is a 
valuable remedy in small doses in the second stage of acute desquam- 
ative nephritis, but in the instances where the writer has seen it 
used it has made matters much worse although it is supposed to 
decrease the quantity of the albumin and blood. In the later stages 
where the kidneys are relaxed and torpid or where albuminuria 
comes on on the slightest exertion, cantharides in the doses of one 
drop of the tincture three times a day is of service. 

In cases of chronic nephritis, particularly where alcoholism is the 
cause of the disease and the kidney is inactive, cantharidal tincture 
is very useful. In pyelitis and in chronic cystitis it is of service, and 
it has been recommended very highly in drop doses in irritability of 
the bladder in women and children. In these cases the bladder 
must not be inflamed, but irritable from depression. The use of 
cantharides is of value in incontinence of urine of a minor degree, as 
that occurring on coughing, sneezing or laughing in some elderly or 
nervous females, and will often prove of service after many years of 
suffering. In chordee in the dose of one drop twice or thrice daily it 
is of service. For impotence depending upon sexual excess Ringer 
asserts that the use of twenty or thirty drops of the tincture of can- 
tharides with full doses of the tincture of the chloride of iron and 
nux vomica will often relieve the patient and enable him to beget 
children. In gleet of a very chronic type and in prostatorrhoea it is of 
service. Dermatologists have used cantharides internally as a 
remedy in psoriasis, eczema, lichen and prurigo, with asserted great 
success. The dose should be so small as not to irritate the stomach. 

Externally cantharides are used in the production of vesication 
for the purpose of withdrawing water from a small area, or as a 
counter-irritant of some severity in cases of deep-seated inflammations 
(see Counter-irritation). Care should be taken that a sufficient 
amount of the drug be not absorbed to cause strangury aud renal 



CAPSICUM. 99 

irritation. In renal congestions and inflammations the use of can- 
tharides as a counter-irritant is often contra-indicated for this reason. 
In the proportion of one drop of the tincture to forty of water it is 
said to be a very good application for burns, but how it acts is not 
known. 

Administration. — The dose of the tincture (Tinetura Cantharidis, 
U. S. and B. P.) is from one to twenty drops, and it is the ouly 
preparation used internally. The cerate (Ceratum Cantharidis, U.S.) 
is used as a blister spread upon a rag, and the cerate of the extract 
Ceratum Extracti Cantharidis, U. S.), is used for the same purposes 
and in the same manner. The Cantharidal Collodion (Collodium cum 
Cantharide, U. S.) is a method of applying the blister which is most 
cleanly, but there is more danger from absorption if it is used. The 
collodion acts as a protective to the part. The papers of cantharides 
(Charta Cantharidis, U S. and B. P.) are used as blisters, but are 
weak in action. The liniment of cantharides (Linimenlum Canthar- 
idis, U S.) is employed as a counter-irritant. 

" Warming plaster " (Emplastrum Picis cum Cantharide, U.S.) is 
a mild counter-irritant to be employed where a blister is too severe. 
The preparations of the B, P., other than those named, are Acetum 
Cantharidis, Charta Epispastica, Emplastrum Calefaciens, Emplas- 
trum Cantharidis, Liquor Epispasticus and Unguentum Cantharidis. 



CAPSICUM. 

Capsicum (U. S.) (Capsici Fructus, B. P.), or Cayenne pepper, is 
the fruit of Capsicum fastigiatum, a native of tropical Africa and of 
Central America. It occurs in long ovoid pods which, when ripe, 
are scarlet red and possess a very hot, burning taste. The active 
principle is capsicin, which is a dark, reddish liquid, or, in other 
words, is a volatile alkaloid. 

Physiological Action. — Locally applied to the skin or mucous 
membranes capsicum causes great redness, and, finally, in the case 
of mucous membranes, vesication. The alkaloid will also produce 
these changes in the skin. When used internally for any length of 
time in excess capsicum will cause a chronic or subacute gastritis 
with pain and discomfort over the seat of the liver and stomach. If 
single large doses are used renal irritation and inflammation ensue 
with strangury and high-colored urine. It is said to act as a circu- 
latory stimulant. 

Therapeutics. — In cases of atony of the stomach due to general 
debility, errors in diet, and alcoholism of the chronic type, capsicum 
is one of the best remedies we have. In cases of acute alcoholism the 
gastric mucous membrane is often irritated too much to permit of its 
use, but after the lapse of some days it may be found of benefit to 



100 DRUGS. 

increase the appetite. As a remedy for alcoholism it is quite useful 
since by its stimulating effect and hot sensation it often satisfies, at 
least to some degree, the craving for liquor. Under these circum- 
stances it should be used in the dose of 5 to 10 drops of the tincture 
every four or five hours, or as the oleoresin in pill in the dose of J 
to 1 grain. The following prescription has been found of great ser- 
vice in the wards under the writer's charge at St. Agnes's Hospital 
in these cases : 

$. — Tr. capsici . f^ij. 

Tr. opii deodorat. ....... f gj. 

Spt. sether. nitrosi f£pj- 

Spt. lavendulse f 3 v j . 

M. — S. Dessertspoonful every four or five hours. 

In the flatulent colic of old persons and young adults capsicum will 
be found not only to act as a carminative but also to prevent the 
development of the gas. In low fevers it has been used as a diffus- 
ible stimulant, but it is of doubtful value. It is rather in the 
anorexia of convalescence that capsicum acts most favorably. In 
chronic nephritis it is of considerable service and it checks albumin- 
uria, but it is only to be used in the chronic forms and stages. The 
tincture is to be given under these circumstances in the dose of 
twenty drops or less, but in some cases, which are very chronic, as 
much as forty drops may be used. In sore-throat and simple tonsil- 
litis the tincture of capsicum and glycerin, half and half, are very 
useful as a local application applied by means of a swab. The same 
preparation may be used as a gargle in relaxed uvula and sore-throat. 
Applied externally capsicum acts as a counter-irritant, producing red- 
ness of the skin, but not a blister in the ordinary individual. It is 
one of the best moderate counter-irritants which can be used, and it 
may be employed by saturating blotting-paper, time and time again, 
allowing it to dry between each dip, in the tincture of caspicum. 
This paper should finally be placed when warm and wet over the 
part and held closely to the skin by a compress. Capsicum plaster 
(Emplastrum Capsici, U. S.) is useful in lumbago, rheumatism, and in 
headache, applied to the nape of the neck. The tincture is some- 
times painted over chilblains which are unbroken. The following 
method given by Ringer, from Rheims, is very efficacious in this 
annoying affection : 

" Make a strong tincture of capsicum pods by steeping them for 
several days in a warm place, in twice their weight of rectified 
spirits of wine. Dissolve gum arabic in water to about the consist- 
ence of treacle. Add to this an equal quantity of the tincture, stir- 
ring together with a small brush, or a large camePs-hair pencil, 
until they are well incorporated. The mixture will be cloudy and 
opaque. Take sheets of silk or tissue paper; give them, with the 
brush, a coat of the mixture ; let them dry, and then give another. 



CARBOLIC ACID. 101 

Let that dry, and if the surface is shining, there is enough of the 
peppered gum ; if not, give a third coat. This paper should be 
applied in the same way as court-plaster to chilblains that are not 
broken, and burns that are not blistered, and speedily relieves the 
itching and pain. It acts like a charm and effects a rapid cure. 
The same is true of discolored bruises. It likewise allays rheumatic 
pains in the joints." 

The dose of capsicum is 1 to 2 grains in powder, on food or in 
pill. The dose of the tincture of capsicum (Tinetura Capsici, U. S. 
and B. P.) is 10 to 30 drops, and of the oleoresin (Oleoresina 
Capsici, U. S.), J to \ grain. The dose of the fluid extract 
(Extractum Capsici Fluidum, U. S.) is 1 to 3 minims.' The plaster 
(Emplastrum Capsici, U. S.) is useful for external applications. 



CARBOLIC ACID. 

Carbolic Acid (Acidum Carbolicum, U. S. and B. P.) is also known 
as Phenol, Pheuylic Alcohol, and Phenic Acid. Not only is it an 
acid, but in addition it is an alcohol of the peculiar group known as 
the phenols, which are derived from coal tar by a process of distilla- 
tion. 

It has a peculiar characteristic odor and varies in color according 
to its method of preparation and purity. It is soluble in 20 per 
cent, of water, but is liquefied by the addition of 6 per cent, of water. 

If the crystals be exposed to the air they undergo liquefaction, 
and in consequence the purest carbolic acid is usually prescribed in 
drop doses rather than grains. It is soluble in alcohol, ether, chloro- 
form, glycerin, and most oils. It unites with alkaline bases to form 
salts, carbolates, but these are very readily decomposed by the feeblest 
acids, such as carbonic acid. 

Physiological Action.- — Locally applied, carbolic acid produces at 
first a burning over the skin, accompanied by a diffuse reddening of 
the surface. If the solution be very strong the part at once becomes 
temporarily painful, then bleached and numb, so that tactile sensi- 
bility is destroyed. Applied to mucous membrane it causes similar 
changes, but to a more marked degree, and may even act as a mode- 
rately severe caustic of a superficial type. Owing to the local coagu- 
lation of albumin produced by it, it cannot penetrate very deeply. 

Nervous System. — Carbolic acid acts as a depressant and para- 
lyzant to the peripheral sensory nerves when locally applied. Upon 
the higher centres in the brain the acid produces a condition of de- 
pression and stupor. 

The convulsions which sometimes occur after toxic doses are spinal 
in origin, as they occur after section of the spinal cord. The motor 
nerves escape almost untouched, as do also the muscles. 



102 DRUGS. 

Circulation. — Upon the circulation in the higher animals the 
drug exercises a distinct depressant influence, stopping the heart in 
diastole in lethal dose and paralyzing the vasomotor centre even 
before the cardiac muscle is affected. These changes only follow 
lethal doses. Small medicinal doses have no effect of any moment 
on the circulation. 

Respiration. — After large doses the breathing becomes more 
rapid and full. These changes, according to Salkowski and others, 
are due to stimulation of the respiratory centres and the peripheral 
vagi. Lethal doses almost invariably kill by failure of respiration 
due to depression of the centres. 

Temperature. — Carbolic acid acts as a depressant to normal 
bodily temperature even in medicinal dose, and also decreases the 
bodily heat in fever. It lowers fever by diminishing heat production 
and increasing heat dissipation. (Hare.) 

Kidneys and Elimination. — In overdose the kidneys may 
become so irritated that total urinary suppression may occur. Car- 
bolic acid causes the urine, under such circumstances, to become 
browmish-black, owing to the manner in which it is eliminated, 
namely, as a sulphocarbolate, formed by its uniting with the sul- 
phates in the body. It is also eliminated as glyco-uronic acid, and 
is partly burnt up in the body. 

It is to be distinctly understood that the dark urine of carbolic- 
acid poisoning is not due to the presence of blood or any of its 
educts. 

Poisoning, Prolonged and Acute. — As the changes in the tissues of 
the body produced by prolonged and sudden over-use of carbolic acid 
are identical they may be considered together. 

Carbolic acid is one of the most rapidly acting poisons known to 
man, notwithstanding the fact that few people seem to realize this 
fact. If a large lethal dose be swallowed a man may drop dead 
within a few feet of the spot where he stood when drinking it, or 
may perhaps live a few hours. In cases where death has occurred 
suddenly, the cause has been failure of respiration. If the patient 
does not die at once all the evidences of gastro-enteritis come on. 
Violent vomiting and purging may ensue and burning pain in the 
entire abdomen is a prominent symptom. The skin is wet with 
sweat, the face pinched and anxious. Collapse, with a thready, im- 
perceptible pulse and extreme dyspnoea, may be present. The mouth 
and lips may not smell of the drug, but the mucous membrane will 
be seen to be corrugated and stained black if impure acid has been 
taken, or whitish if the pure drug has been used. The eschar on 
the membranes is a peculiar one, and is pathognomonic of the poison, 
having a white centre surrounded by a reddened and inflamed zone, 
the centre sometimes becoming dark-brown or black. The post- 
mortem will show these spots in the oesophagus and stomach, and 
even in the intestines ; and all the internal organs, as the brain, kid- 



CARBOLIC ACID. 103 

neys, liver, and spleen, will be found filled by dark grumous blood, 
while on opening the body the strong odor of the acid will be per- 
ceived. A peculiar croupous exudate is sometimes found in the 
bronchial tubes, and fatty degeneration of a more or less widespread 
type is often seen in carbolic-acid poisoning. 

A large number of cases are on record in which carbolic-acid 
poisoning ensued from absorption from surgical dressings. One of 
the earliest signs of such a state of affairs is the darkened smoky 
urine and a slight nervous unrest or cerebral disturbance. Very 
often pain in the lumbar region indicates kidney strain and irrita- 
tion. The dressings should, of course, be at once removed. 

Treatment of Poisoning. — The chemical antidote is any soluble 
sulphate, such as Epsom or Glauber salts, which form insoluble sul- 
pho-carbolates. As these salts follow the acid into the bloodvessels 
and tissues to unite with it, the mere fact that hours have elapsed 
since the poison has been taken does not invalidate the propriety of 
using these sulphates. The further treatment consists in the admin- 
istration of warm mucilaginous drinks, hot applications to the ex- 
tremities, cardiac and respiratory stimulants, such as digitalis and 
strychnine, and counter-irritation over the abdomen. Emetics and 
the stomach-pump should be used if possible, but the former are 
generally useless because of the state of the stomach. 

Therapeutics. — Internally carbolic acid is little used, but, never- 
theless, has a very favorable effect in certain states. In nervous 
vomiting, or in that due to gastric irritation, the drug does good in J 
to 2 drop doses by depressing the sensory nerves in the stomach. 

In diarrhoea depending upon fermentation, from 2 to 5 drops ot 
the acid do great good, combined with 10 to 20 grains of bismuth 
and administered in powder or in capsule. 

In gangrene and tuberculosis of the lung a spray of the acid in 
water in the strength of 5 to 15 drops to the ounce may do some 
good and at least stop the cough and relieve the irritation and tickling 
in the throat. 1 Creasote is, however, generally preferred in these con- 
ditions at the present time. 

Externally the acid is very largely employed as an antiseptic lotion, 
and in a solution in which to place instruments while operating. 
The solutions for this purpose should be in the proportion of 1 to 20 
of water (see Antiseptics). 

Carbolic acid is rarely used directly over wounds in dressings at this 
time, unless the dressing be one of carbolized oil. Other drugs have 
supplanted it. The use of the carbolized spray over wounds has been 
found of more harm than good, and ought never to be used. In 
diphtheria, ulcerated sore-throat, and even in ordinary stomatitis, car- 
bolic acid will be found of value in a spray or mouth-wash, and in 

1 The spray must be a very fine one, or it will not carry the drug far enough down 
into the lungs to do any good. 



104 DRUGS. 

ordinary sore-throat, in the strength of 1 to 100, will be found, when 
applied on a swab or by a gargle, to relieve the pain and inflammation. 
In burns carbolized sweet-oil in the proportion of 1 drachm of the 
acid to each 6 ounces makes one of the best dressings that can be 
used. By means of the local anaesthesia produced by the acid minor 
operations, such as eversion of the toe-nail or opening a felon, may be 
performed by soaking the part for ten minutes in a solution of 30 parts 
to 100 and applying the pure acid by means of a brush to the line of 
the incision. Carbolic acid may be used as a lotion in the itching of 
jaundice in the proportion of 10 grains of the acid to 2 drachms of 
glycerin and 2 drachms of water. In enlarged glands which have 
not yet gone on to suppuration, intra-glandular injections with a 
hypodermic needle are of value in a large number of cases, the solu- 
tion used being no weaker or stronger than 2 per cent. 5 to 10 
minims of this solution is sufficient for each gland. In buboes 10 
minims of a solution of 8 grains to the ounce may be injected into 
the swelling, the skin being first benumbed by an ether spray. This 
is a most successful treatment. The same treatment may be applied 
to cJwonic synovitis and repeated every three days, and boils and car- 
buncles may even be so treated with great success if the measure be 
used early enough to abort the trouble. 

In the form of an ointment carbolic acid may be used in the 
strength of 10 minims to the ounce of simple cerate, particularly in 
subacute eczema where there is great weeping and itching. 

As a disinfectant carbolic acid ranks among the poorest of those 
which stand well with the popular idea ; 1 to 2 per cent, solutions, 
however, kill most spores and germs. 

Administration. — Carbolic acid ointment ( Unguentum Acidi Car- 
bolici, U. S. and B. P.) is the only officinal preparation in the If. 8. 
P. In the B. P. the following preparations are officinal : Acidum 
Carbolicum Liquefaction, given in the dose of 1 to 2 minims ; Glyce- 
rinum Acidi Carbolici, and Suppositoria Acidi Carbolici cum Sapone ; 
each suppository containing 1 grain of carbolic acid. 



CARBON: CHARCOAL. 

Carbo Ligni ( U. S. and B. P.), or Charcoal, is prepared by the 
exposure of soft wood to a red heat, air being prevented from 
coming in contact with it during the process. Charcoal should be a 
black, brittle, somewhat shiny, porous substance, devoid of taste, of 
odor, and completely insoluble in water. Owing to its power of 
absorbing a very large amount of certain gases, it is of value in 
medicine in states where these gases abound. 

Therapeutics. — Charcoal is used externally as an application to 
old sores or sloughs to act as a deodorant and antiseptic. This is ac- 



CARBON BISULPHIDE. 105 

complished by the absorption of the liquids, thereby depriving germs 
of a nidus, and by its distinct oxidizing power. It may be applied 
in the form of a dry powder or in a poultice, which is, however, so 
uncleanly that other antiseptic dressings are better. 

The poultice (Cataplasma Carbonis, B. P.), if used, should be 
made made in the following manner : Take of powdered wood- 
charcoal J ounce, bread-crumbs 2 ounces, linseed meal 1^ ounces, and 
add boiling water 10 fluidounces. Macerate the bread-crumbs and 
meal for ten minutes over the fire, and then stir in the charcoal to 
the extent of half the amount just named. Spread out the poultice 
and sprinkle the remaining half of the charcoal over its surface, and 
apply to the part affected while hot. 

Internally, charcoal is used in powder in many conditions, and does 
very well indeed in cases of so-called " sour stomach" from which 
eructations of gas or sour liquids take place. As ordinary charcoal 
is not always obtainable, it may be substituted by pieces of very thin 
toast burnt to a state of charcoal, through and through. A few of 
these pieces will, when eaten, often stop all the symptoms mentioned. 
If the attack is very severe and vomiting eventually ensues, the 
ejecta will commonly be found to be odorless and not sour, and the 
stools will also be almost odorless, though black. In fermentative 
and acid diarrhoeas in children and adults this method of treatment 
is often of value. 

As a filter for impure water, charcoal, in mass or in powder, is one 
of most satisfactorv substances we have. 



CARBON BISULPHIDE. 

Carbonei Bisulphidum, U. S., is a clear, colorless, highly refractive 
liquid, having a strong characteristic odor, a sharp aromatic taste, and 
a neutral reaction. 

Poisoning. — The symptoms of poisoning by bisulphide of carbon 
consist in headache and nervous excitement resembling in many 
respects the symptoms of belladonna poisoning, particularly in the 
volubility of the patient and the evidences of hysterical tendencies. 

Prolonged exposure to the fumes of this drug causes great cachexia 
and pallor, accompanied by muscular weakness and failure of intel- 
lectual power. Sometimes convulsions of an epileptiform character 
come on. 

The treatment of poisoning by bisulphide of carbon consists in 
quieting the nervous system if convulsive disorders are present, by 
the use of bromide of potassium and chloral, and in supporting the 
circulatory system if any evidences of its failure manifest themselves. 
Circulatory depression is not, however, a common condition except 
in very advanced poisoning. 



106 DRUGS. 

Therapeutics. — Bisulphide of carbon has been used in medicine 
externally over enlarged lymphatic glauds. The application is made 
by placing the liquid in a bottle of such a size that the mouth is 
large enough to cover the diseased area. In the bottle should be 
placed a sponge large enough to contain a fluidrachm of the drug, 
and the skin over the glaud should be well moistened with water. 

The vapor derived from the drug under these circumstances is an 
active agent in promoting a cure. Bisulphide of carbon has also been 
used in a similar manner in the treatment of neuralgia. 



CARBONATE OF POTASSIUM. 

Carbonate of Potassium (Potassii Carbonas, U. S. and JB. P.). This 
salt is never used in medicine, except to prepare other salts, as it is 
disagreeable to the taste and an irritant (see Potassium Citrate). 



CARBONATE OF ZINC. 

Precipitated Carbonate of Zinc {Zinci Carbonas Precipitatus, U. 8. 9 
Zinci Carbonas, B. P.) is used as a protective, rather astringent, 
powder, over weeping eczema and similar moist discharges. It 
may be employed to fulfil all the indications for the oxide of zinc. 
At one time it was very largely used, not as the precipitated carbo- 
nate, but as the impure carbonate, under the name of calamine. 



CASCARA SAGRADA. 

Cascara Sagrada is the bark of the Phamnus Purshiana, a plant 
growing in California. It is sometimes called California buckthorn, 
to distinguish it from ordinary buckthorn, or Rhamnus Frangula, 
which it closely resembles in many ways, and which may be used as 
a substitute for cascara sagrada. 

Therapeutics. — Cascara sagrada ought never to be used as a purge 
but solely as a laxative. It is by far the best remedy when em- 
ployed to simply empty the bowel of fsecal matter in cases of consti- 
pation, since it not only performs this function without intestinal 
disturbance, but simultaneously acts as a tonic to the bowel, and so 
prevents the constipation which usually follows the use of all other 
drugs of its class. 

Though unofficinal it is most commonly employed in this country in 
the form of the fluid extract (Extractum Cascarce Sagrada? Liquidum, 



CASSIA FISTULA. 107 

B. P.) in the dose of from 10 to 20 drops at night, or morning and 
night. If 20 drops fail to act 30 drops may be used, but if larger 
doses are required other drugs should be employed, as fluid rachm 
doses have been known to act as an irritant and produce enteritis 
and intestinal catarrh. The objection to cascara sagrada is its bitter 
taste, which may be partially overcome by the additional use of the 
Elixir Aurantii, in the proportion of 1 part of the cascara extract to 
2 parts of the orange peel. 

Some of the preparations are now made in an almost tasteless 
form, such as " Cascara Cordial," or the non-bitter fluid extract, 
made by a prominent firm in this country. The solid extract 
(Extractum Cascarce Sagradce) is officinal in the B. P., and given in 
the dose of 2 to 8 grains in pill. 



CARDAMOM. 

Cardamom {Cardamomum, U. S.) is the fruit of Elettaria Carda- 
momum, and is a bitter tonic possessing some aromatic properties. It 
is useful in cases of atony of the stomach and small intestine, particularly 
if combined with some other bitter, such as gentian, and a mineral 
acid. Cardamom is officinal in the B. P. as Cardamomi Semina. 

If the intestine is atonic and secretion is deficient, the following 
prescription will be found of value : 

R. — Acid, nitric, dil f.^j. 

TV. cardamomi comp. . . . . . q. s. f^vj. 

M. — S. Dessertspoonful after each meal. 1 

Administration. — The officinal preparations are the tincture of 
cardamoms (Tinctura Cardamomi, U. S.), dose 1 to 3 drachms; and 
the compound tincture (Tinctura Cardamomi Composita, U. S. and 
B. P.), which is to be given in the same dose as the tincture. It is 
also a constituent of the officinal aromatic powder (Pulvis Aromat- 
icus, U. S.). 

CASSIA FISTULA. 

Cassia Fistula, U. S., is the fruit of Cassia Fistula, or Purging 
Cassia, as it is sometimes called, and occurs in long, dark-brown pods 
containing a dark pulp in each segment. This pulp is the useful 
part of the drug, and is officinal in the B. P. as Cassice Pulpa. It 
ought never to be used alone, as it is too apt to cause pain and 

] While the rule that an acid is incompatible with a tincture is not recognized in this 
mixture, the quantities of acid and alcohol are so disproportionate that no ether of any 
amount is developed. 



108 DRUGS. 

griping, but it is officinally present in the Confection of Senna (Con- 
feetio Sennce, U. 8. and B. P.), and may be given in the dose of J 
drachm to 1 drachm as a laxative, or as much as J ounce if a pur- 
gative effect is desired. 



CASTOR OIL. 

Castor Oil [Oleum Ricini, U. 8. and B. P.) is a fixed oil, derived 
by expression from the beans of Ricinus Communis, a plant of the 
United States and elsewhere, but originally derived from India. It 
contains an acrid substance, ricinoleic acid. 

Physiological Action. — The manner in which castor oil purges is 
somewhat in doubt, but is probably dependent upon the presence of 
the acid just named and the fact that it is an oil. 

As is well known, oils, such as olive oil, for example, if given in 
any quantity tend to move the bowels, and the ricinoleic acid, which 
is somewhat acrid, stimulates the small and large gut, and so devel- 
opes peristaltic movement. According to some writers, this acid is 
not set free until the oil is attacked by the pancreatic juice. That 
this acid possesses purgative properties of itself seems proved by the 
fact that the oil will purge when it is rubbed in by the skin, and that 
nursing mothers on taking the oil eliminate the acid in the milk 
so that the suckling is purged. According to the studies of Ruther- 
ford aud Yigual, the oil has no effect over biliary secretion other 
than that violent purgation indirectly increases biliary flow, and the 
researches of Hess have shown that the oil acts more rapidly in the 
small than in the large gut, and only produces peristalsis by coming 
in contact with the mucous membrane. 

Therapeutics. — Castor oil is the blandest and most unirritating 
purge we have except the sulphate of magnesium, which is depletant 
and much more rapid in its effects. While the Epsom salts will act 
in one-half to one hour if the stomach be empty, castor oil will gen- 
erally act in four hours, or perhaps five. The regularity of its action 
can almost be used as a timepiece, so constant is it. Castor oil is 
used whenever irritant materials, such as bad food, putrid flesh, or 
decaying or green vegetables have been eaten, even if the inflamma- 
tion set up after them is very active. If hard bodies, such as broken 
cherry-stones, have been swallowed, it is far better than sulphate of 
magnesium, as it is more gentle and lubricates the gut, thereby pre- 
venting scraping aud irritation. Where mucus has accumulated in 
the bowel in children, and must be gotten rid of before other treat- 
ment is resorted to, castor oil should be used. In parturition it has 
been used largely to relieve the bowels of faecal matter, and is said by 
old practitioners to make the labor easier than if any other purge is 



CATECHU. 109 

employed. It is also employed in the constipation following acute 
diseases, and in infants and children. 

The disadvantages of castor oil lie in its taste, the fact that it is 
oily, that it tends to produce haemorrhoids if used constantly, and, 
finally that its frequent use, or even a single dose, is generally fol- 
lowed by more obstinate constipation than before. This is one of 
the reasons why it is useful in irritative diarrhoeas. The effect of 
castor oil is very much increased if a little bicarbonate of sodium be 
given with it. 

Administration. — Castor oil is very much more agreeable to the 
taste if pure than if poorly prepared. It is also true that too great 
purity, so far as taste is concerned, renders it less active. 

The methods directed for taking castor oil are as various as 
the tastes of the individuals. Its odor may be covered by a drop 
or two of the oil of bitter almouds, but emulsions of the oil are 
not of any service, save to prevent its efficiency. Some take the 
oil in the foam of beer or porter, others in syrup of sarsaparilla and 
soda-water, and still others in milk or cream. A good way of taking 
it is to eat one or two strong cream peppermint drops, or even the 
crystalline drops, swallow the oil from a spoon which is placed well 
back in the mouth, and immediately eat several other peppermints. 
The same plan is bettered by using the oil in milk or water, so that 
the liquid carries the oil down into the oesophagus without touching 
the mucous membranes. It may also be taken in highly seasoned 
beef-tea. Ringer recommends the following : \ ounce of oil, fresh 
syrup of acacia 3 drachms, and distilled water 5 drachms, flavored 
with a little oil of lemon or peppermint. Wood advises that it be 
mixed with glycerin, equal parts, to which is added a drop or two 
of oil of gaultheria or oil of cinnamon. 

The dose for an infant is 1 to 2 teaspoonfuls, and for an adult 
\ ounce to 1 ounce. 

Owing to the fact that the oil will very frequently produce griping, 
a few drops of laudanum should be added to it, or tincture of bella- 
donna may be used. If these cannot be employed, a drop of oil of 
cinnamon is equally useful for this purpose. 



CATECHU. 

Catechu (U. S.) is derived as an extract from Acacia Catechu. 
The catechu of the U. S. P. is true catechu ; that of the B. P. is in 
reality an extract of gambier, being derived from the leaves and 
shoots of Uncaria Gambier. Catechu depends for its medicinal 
value upon the astringent properties which it possesses. Beyond 
this power it has no particular value. 

It is of a dark-red color, has a somewhat sweetish taste, and is 
soluble, like most extracts, in water. 



110 DRUGS. 

Therapeutics. — Like all the vegetable astringents catechu is used 
as a remedy for diarrhoea, particularly that of the serous type, or that 
consisting of stools of too fluid a consistency. If large amounts of 
mucus in the passages show a catarrhal state of the bowel, the mucus 
should be displaced by a purge of castor oil or sulphate of magnesium 
before the astringent is used. 

Catechu may or may not be combined with opium in cases of 
diarrhoea, but the following prescription will be found of service: 

For an adult : 

R . — Tinct. catechu composit f^U- 

Tinct. opii. camphorataa . . . . . . f!|ij. 

Mist, cretse q. s. f'^ij. 

M. — S. Dessertspoonful every 4 hours till relieved. To be shaken before 
using. 

In cases of sore-throat, where the secretion is excessive and the 
inflammation subacute, catechu may be used as a gargle. 

In cases of spongy gums catechu is sometimes useful as a mouth- 
wash. If the powdered catechu is used internally the dose is 2 to 
30 grains. The dose of the Compound Tincture of Catechu (Tinc- 
tura Catechu Composita, U. 8.) is 1 to 2 fluidrachms. The Troches 
of Catechu (Trochisci Catechu, U. 8. and B. P.) are to be employed 
in sore-throat and are to be held in the mouth. They are not gener- 
ally used. 

The officinal preparations of the B. P. beside the ones given are : 
Infusum Catechu, given in the dose of 1 to 1 J fluidounces ; the tinc- 
ture (Tinctura Catechu), dose 1 to 2 fluidrachms, and a compound 
powder (Pulvis Catechu Compositus), composed of catechu, kino, and 
rhatany, the dose of which is 20 to 40 grains. 



CAUSTIC POTASH. 

Caustic Potash (Potassa, U. 8., Potassa Caustica, B. P.) is a very 
deliquescent hard white solid, possessing powerful caustic powers, 
and used in medicine for the purpose of burning away growths or 
exuberant ulcers. A piece should be placed on the skin by means of 
a pair of forceps, when it at once softens down and burns the tissues 
until it can reach no further. The surrounding skin should be pro- 
tected by wax, suet or oils, and a piece of adhesive plaster with a 
hole for the growth should first be applied to prevent any action on 
the healthy tissues. This is a very painful burn and should not 
generally be resorted to. When the caustic has acted sufficiently it 
is to be washed off with vinegar or other dilute acid. Vienna paste 
(Potassa cum Calce, U. 8.) is used for the same purposes as the 
caustic potash. 



CHIMAPHILA. Ill 



CAUSTIC SODA. 

Caustic soda (Soda, TJ. S., Soda Caustica, B. P.) is milder than 
caustic potash, and is more readily controlled. It should be used in 
the same way for the same purposes, and the surrounding skin pro- 
tected by adhesive plaster and oil or ointment. 

It must be kept in well-stoppered bottles made of hard strong 
glass. The only officinal preparation in the TJ. S. P. is Liquor Sodce, 
or solution of soda. 



CERIUM OXALATE. 

Cerium oxalate (Cerii Oxalas, TJ. S. and B. P.) is a white granular 
powder, permanent when exposed to the air, odorless and tasteless, 
and insoluble in water and alcohol, but freely so in hydrochloric acid. 

Therapeutics. — It is used in the vomiting of pregnancy or that due 
to uterine disorders and displacements, and in some cases of gastric 
acidity instead of bismuth. The dose is from 2 to 5 grains given 
in pill form every 4 to 5 hours. 



CHENOPODIUM. 

Chenopodium ( TJ. S.) is the fruit of the Chenopodium Ambrosioides 
or American wormseed. The seeds contain a volatile oil and have a 
distinct and rather disagreeable aromatic odor. These seeds rubbed 
up into a powdered form with a syrup form an electuary which is 
most efficient against the ascaris lumbricoides or round-worm as it occurs 
in children. The dose of the powdered seeds is from 10 to 30 grains. 
The better way of using chenopodium is in the form of the oil (Oleum 
Chenopodii, TJ. S.) in the dose of 10 drops to a child of five years, 
either on sugar or in an emulsion made of gum acacia. The meas- 
ures adopted for the treatment of worms should be insisted upon 
before the drug is given. (See article on Worms.) 



CHIMAPHILA, 

Chimaphila ( TJ. S.), or Pipsissewa, is the leaves of Ckimaphila 
Umbellata, an evergreen found in America, Europe, and Asia. 

Therapeutics. — Pipsissewa is a drug employed in atonic renal con- 
ditions, particularly of the functional type, as a stimulating diuretic 
which will bring into activity the secreting structure of the kidney 



112 DRUGS. 

and the mucous membranes of the genito-urinary tract. It is also a 
tonic to the stomach. For this reason it is often placed in mixtures 
given to dropsical patients if debility and anorexia are present. In 
ulcers of the skin due to struma it is said to be of service, and it 
probably has some slight alterative power. The drug may be used 
in the form of a decoction, which is not officinal, in the dose of 1 to 
3 fluidounces, and as the fluid extract (Extractum Chimaphilo? 
Fluidum, U. 8.) in the dose of J to 1 drachm. 



CHIRETTA. 

Chiretta {Chirata, U. 8. and B. P.), is the plant Ophelia Chirata, 
which is a native of India. It is a bitter tonic, possessiug a very 
distinct influence over the liver, and, unlike many bitter tonics, is 
devoid of tannic acid. For this reason it may be used with prep- 
arations of iron. Chiretta may be given in all cases of indigestion 
and loss of appetite, particularly where the liver is torpid and if any 
tendency to constipation is present, although it is not directly laxa- 
tive. When given in powder the dose is 20 grains ; the dose of the 
fluid extract (Extractum Chirata Fluidum, U. 8.) is 30 drops to 1 
drachm, while that of the tincture (Tinctura Chiratce, U. 8. and B. P.) 
is 1 to 4 drachms. The unofficinal solid extract may be given in pill 
in the dose of 2 to 4 grains. The dose of the infusion (Infusum 
Chiratce, B. P.) is a wineglassful. 



CHLORAL. 

Chloral ( U. 8.). Although the name chloral is applied to the sub- 
stance used in medicine, chloral proper is never so employed, hydrate 
of chloral (Chloral Hydras, B. P.) being the real preparation. It is 
a white, crystalline body, but is often sold in irregular broken 
masses, which are generally impure. 

Physiological Action. — When chloral is applied to a mucous mem- 
brane it causes distinct reddening and burning pain, and finally 
acute inflammation. It is, therefore, a local irritant. Chloral acts 
as chloral, and is not broken up into formic acid and chloroform, as 
taught at one time. 

Nervous System. — In medicinal and toxic dose chloral produces 
sleep by quieting the intellectual centres in the brain, at the same time 
depressing the motor tract of the spinal cord and the motor nerves. 
In medicinal amounts it does not decrease sensation, but in toxic 
dose it does do so. Very often hyperesthesia results from small 
doses. Reflex action is decreased by its influence on the motor 
columns of the spinal cord. 



CHLORAL. 113 

Circulation. — The dose of 10 to 20 grains in the adult rarely 
causes any circulatory changes, but larger amounts produce a fall of 
arterial pressure due to a direct depression of the heart muscle, as 
chloral is a cardiac depressant. 

After death from chloral the blood may be found dark and 
grumous- looking, with the corpuscles broken down, but these 
changes occur only after very large doses. 

Respiration. — In moderate amounts no respiratory effect is 
felt, but in toxic doses the breathing becomes slower and slower, 
and more and more shallow, until it stops in death. Death from 
chloral is due to respiratory failure, with an almost simultaneous 
stoppage of the heart. 

Temperature. — Chloral tends to lower bodily heat, and in large 
doses produces a very marked fall of temperature, which does much 
toward causing death. Brunton has found that rabbits will survive 
very large doses if external heat is applied to them. The fall of 
temperature is, at least in part, due to the failure of the circulation 
and vaso-motor dilatation. 

Kidneys, Tissue-waste, and Elimination. — Chloral is elimi- 
nated by the kidneys in the form of uro-chloralic acid, and if given 
in excess, as chloral. Large amounts irritate these organs and may 
produce bloody urine, owing to the nephritis which is set up as the 
drug passes through the renal structures. When chloral is taken the 
urine will often give Fehling's test for sugar. 

Poisoning. — When a poisonous dose of chloral is taken the person 
soon falls asleep and sinks into a deep coma. The respirations become 
at first slow and labored, then shallow and feeble. The pulse, at first 
perhaps a little slowed, soon becomes rapid, thready, and shuttle-like, 
and is finally lost at the wrist. The face is white and livid, the 
forehead and the hands covered with a cold sweat, and the pupils, 
w T hich are at first contracted, soon become widely dilated. Absolute 
muscular relaxation is present, and it is impossible to arouse the 
patient. 

Treatment of Poisoning. — The physician should apply external 
heat, and first use emetics in the early stages, or if the case is seen too 
late for emetics he should use the stomach-pump. Strychnine should 
be given in full dose, -^ to -^ of a grain, to stimulate respiration, or 
atropin may be used for the same purpose. The heart is to be sup- 
ported by 10 drop doses of tincture of digitalis given hypodermically 
every twenty minutes until some effect is noted and the rather slow 
digitalis preceded by ether and ammonia or brandy or whiskey. 
The patient must not raise the head to vomit, and the head should 
be placed below the heels to keep the blood in the brain. 

In chronic poisoning the patient suffers from weakness, mental and 
physical, with sudden flushings due to vaso-motor disorder, from 
palpitation of the heart, and finally from petechial eruptions, ulcera- 
tions and sloughs. 



114 DRUGS. 

Therapeutics. — Chloral is the purest hypnotic that we have, and 
may therefore be used where simple nervous insomnia is present, 
but not where the sleeplessness is due to pain. Under such circum- 
stances it is to be employed in the combination of 10 grains of 
chloral with jr of a grain of morphine, as a much more powerful 
hypnotic effect is produced by the combined action of the two drugs 
than by the use of either one of them alone. 

In tetanus and strychnine poisoning it is the best remedy we have, 
as it depresses the motor tract of the spinal cord. In such a case it 
should be given in 20-grain doses combined with 60 grains of bro- 
mide of potassium. If the convulsion prevents deglutition, or is 
brought on by swallowing, the remedy should be used by the rectum, 
and if the spasm expels it from the rectum the patient should be 
chloroformed long enough to allow the injection to be given and 
absorbed. The same remedies in small doses are to be used in infantile 
convulsions and in infantile colic in the dose of J grain to 1 grain of 
chloral to 2 grains of bromide of potassium or sodium in a teaspoon- 
ful of peppermint-water. In chorea, paralysis agitans and delirium 
tremens chloral is of great service, but must be given cautiously in the 
latter case for fear it may depress the heart, which is already diseased 
by alcoholic excess. Cases are on record where chloral has caused 
sudden death from cardiac failure in the persons of alcoholics who 
were suffering from fatty heart. 

Chloral has been used in labor pains, but is rarely so employed, and 
is not a good remedy. If much rigidity of the os uteri exists chloral 
may be used with advantage to relax the spasm. The dose given 
should be 15 grains. In uroemic convulsions it has been highly ex- 
tolled, but if any acute renal trouble is present it must not be used. 
In puerperal convulsions not dependent upon nephritis 30 grains may 
be given and repeated in one or two hours. 

Hiccough, nocturnal epilepsy and whooping-cough are all indications 
for its use, but in asthma it rarely does good, and if pushed is 
dangerous to the heart. 

As an antiseptic chloral possesses a good deal of power, but is 
rarely used except to prevent the decomposition of urine and to 
assure the maintenance of purity in urinals used by paralytics, in 
whom the urine is generally heavy and ill-smelling. 

Untoward Effects. — Chloral sometimes causes nausea, purging 
and vomiting, by reason of its irritant action, and sudden cardiac 
failure in heart disease has resulted from 20 grains or less. 

Administration. — Chloral should be given in syrup of acacia, 
simple syrup, or water, and should be well diluted. The syrup of 
chloral (Syrupus Chloral, B. P) is given in the dose of 1 fluidrachm. 



CHLOBALAMIDE. 115 



Croton Chloral. 



Croton chloral, or Butyl- Chloral Hydras, B. P., has a physiologi- 
cal action closely allied to chloral itself, but possesses more anaes- 
thetic power and is very much less depressant to the heart and circu- 
lation. The dose for the production of sleep is the same as chloral, 
5 to 20 grains in syrup. 

Therapeutics. — Croton chloral is infinitely preferable to chloral in 
sleeplessness due to pain. 

In faded neuralgia and migraine it is exceedingly efficacious, par- 
ticularly if the fifth nerve be involved. In headaches due to eye- 
strain, and in those associated with sick stomach, but not due to gastric 
indigestion or nervous debility, croton chloral is of service. Curiously 
it is valueless in toothache, but does good in the neuralgia due to 
decayed teeth. 

Administration. — Croton chloral should be used in pill form in 
the dose of 3 to 5 grains every two hours till the pain is relieved or 
sleep comes on, or it may be given in solution or syrup of acacia and 
water, or water and glycerin. It has been used in as large dose as 
60 grains, but 20 to 30 grains ought to be the maximum dose. 



OHLORALAMIDE. 

Chloralamide is a compound very recently introduced, formed by 
the addition of formamide to anhydrate of chloral, and is a color- 
less crystalline substance, soluble in 9 parts of water and 1 J parts 
of alcohol. Its taste is slightly bitter, but not biting, and it keeps 
well in watery solution without decomposition. Its physiological 
action is closely allied to that of chloral, except that it is by no means 
so depressing to the circulation. Upon the nervous system it acts 
chiefly upon the brain and spinal cord, and produces sleep, a result 
naturally expected, since both chloral and formamide are hypnotics. 
It is said not to irritate the stomach and kidneys. 

Therapeutics. — Chloralamide may be employed in medicine when- 
ever chloral may be used. It is decidedly a nervous sedative, and in 
the wakefulness of nervous insomnia is very useful. Sleep generally 
ensues about thirty to forty-five minutes after it is taken. According 
to most of the reports published so far, the drug relieves pain as well 
as produces sleep, and is, therefore, distinct in its action from chloral. 
In neuralgia it is very useful, and it has been found of value in the 
pains of tabes dorsalis. The dose is 10 to 30 grains, which may be 
repeated in three or four hours, although the sleep generally lasts 
five to eight hours. The following formula may be used in its ad* 
ministration : 



116 DRUGS. 

R. — Chloralamide gr. xl. 

Acid, muriat. dil. ....... gtt. v. 

Syrup, simplex fgij- 

Aq. distillat. fgij. 

M. — S. Take in two doses in a little water. 



CHLORATE OF POTASSIUM. 

Chlorate of potassium (Potassii Ohloras, U. S. and B. P.) is a salt 
of potassium differing entirely in physiological action from all the 
other potassium salts, and, with the exception of the cyanide of potas- 
sium, is certainly the most poisonous. Not only is it, when locally 
applied, an irritant to mucous membranes, but it is absorbed into the 
blood and causes changes of a serious character in this fluid, and 
acute nephritis if given in overdose. 

Physiological Action. — It has been thought by some that chlorate 
of potassium gave up a large amount of oxygen to the body, and for 
this reason it would be of value in cases of slow asphyxia, as in 
pueumonia or phthisis. It has even been recommended to persons 
crossing high mountains where the rarity of the air produced dis- 
agreeable effects, but nothing is more absurd than such a belief. 
Chlorate of potassium does give off oxygen when treated with very 
high heat, but not at the temperature of the body. Nearly all of it 
escapes from the body unchanged. 

When overdoses of the chlorate are taken it produces sickness of 
the stomach, headache, pain in the loins and belly, great dyspnoea, 
cyanosis, heart failure, and great weakness. The blood is dark and 
chocolate-looking, the change being due to production of methsemo- 
globin. The blood-corpuscles are crenated and broken down, and 
the liver, kidneys, spleen, and intestines found softened and filled 
with broken-down and disorganized blood. 

Therapeutics. — Chlorate of potassium is useful in stomatitis as a 
mouth-wash, or, when given internally, in the following mixture : 

R. — Potas. chlorat gr. xlviij. 

Tr. myrrh gr. xxiv. 

Elixir calisayse . . . . . . q. s. f^iij. 

M. — S. Teaspoonful every five hours, or as a mouth-wash. 

Owing to the fact that the drug is eliminated by the saliva to a great 
extent, the mucous membranes are constantly bathed by a solution 
of the chlorate when it is ingested. If any irritation of the stomach 
or kidneys exist, the medicament must be used on a swab and none 
of it swallowed. In diphtheria it is very commonly employed, but 
its use is exceedingly dangerous. Death in many cases of diphtheria 
is due to the renal irritation present, an acute nephritis, and this 
drug simply increases the disease-process. If the chlorate of potas- 



CHLORIDE OF ZINC. 117 

sium is employed in diphtheria it should be used on a swab in 
solution. 

In anginose sore-throat chlorate of potassium is a useful gargle, and 
Wood recommends the use of a solution made by adding 1 ounce of 
sumach berries, \ ounce of chlorate of potassium, and 1 pint of boiling 
water to each other and allowing them to simmer for a few hours, 
when the mixture should be strained, cooled, and used as a gargle. 

The following is equally serviceable : 

K.. — Potass, chlorat £j. 

Ext. rhus. glabrae fl. . . . . . f^ss. 

Aq. dest q. s. f'^iij. 

M. — S. To be added to an equal quantity of water in a glass and used as a 
gargle every two hours. 

This makes an abominable-looking pharmaceutical preparation, 
but an exceedingly useful one. 

In acute rectal catarrh with mucous diarrhoea and tenesmus, a solu- 
tion of chlorate of potassium in water, 20 grains to the ounce, injected 
into the bowel, will often produce a cure after one or two injections. 
Not more than 4 ounces should be used, and it ought to be retained 
for twenty minutes. In the treatment of hcemorrhoids a few drops of 
laudanum added to this solution will be found of great service. The 
troches (Trochisci Potassii Chloratis, U. 8. and B. P.) are given in 
the dose of 1 to 6, each lozenge containing 5 grains. 



CHLORIDE OF SODIUM. 

Chloride of Sodium (Sodii Chloridum, U. S. and B. P.), or common 
Salt, is a useful drug and food, aiding in maintaining the alkalinity 
of the blood and tissues, and in the formation of gastric juice, being 
changed by the lactic acid of the stomach into lactate of soda, 
thereby setting free hydrochloric acid, which aids not only in diges- 
tion but in the production of pepsin from the pepsinogen of the 
gastric tubules. The dose is 10 to 20 grains. 



CHLORIDE OP ZINC. 

Chloride of Zinc {Zinci Chloridum, U. S. and B. P.) is a white, 
crystalline, deliquescent powder, of caustic taste and acid reaction, 
possessing considerable disinfectant power. It has been used as an 
eye-wash in the strength of 1 to 2 grains to the ounce, but is rarely 
so employed. The same solution may be used as an injection in the 
second stages of gonorrhoea. Under the name of Liquor Zinci Ohio- 



118 DEUGS. 



ridi, U. S. and B. P., is prepared a strong solution of the salt of the 
strength of about 50 per cent., for disinfectant purposes. 

Numerous experiments with the proprietary "chlorides" show 
them to be of very slight disinfectant power but strongly antiseptic. 



CHLORINATED LIME. 

Chlorinated Lime {Calx Chlorata, U. S., Calx Chlorinata, B. P.), 
is the hydrate of lime containing 25 per cent, of chlorine. It is an 
exceedingly irritant substance, because of the chlorine which is con- 
tained in it, and is never used internally. 

Much of the chlorinated lime sold is useless and contains too little 
or no free chlorine. Good chlorinated lime should be so laden with 
the gas that the face cannot be held near it without the eyes being 
severely irritated. Unless the chlorine is present it is of no value, 
as its employment as a disinfectant depends upon the action of this 
gas, the lime being merely used as a vehicle and oxidizer, as the gas 
itself would be difficult of application. 

Uses. — As a disinfectant chlorinated lime is one of the best, if not 
the best, we possess for privies, drains, and sinks. A few pounds of 
it may be added every week to the contents of a privy vault with 
great advantage, and a solution of it may be used in all bed-pans 
and urinals. When the passages of a patient having typhoid fever 
are to be received in a bed-pan, the solution should be placed in the 
receptacle beforehand, so that the faecal matter or urine will fall at 
once into a disinfectant fluid. The solution should be of the strength 
of 1 pound to 2 gallons. As it is one of the most powerful deodor- 
izers, chlorinated lime should be placed liberally about decaying 
animals, and, in exhuming corpses, sheets wrung out in a solution 
made as above will be found of service, if wrapped about the body, 
to destroy the stench. 

Water which has become foetid by stagnation may be rendered 
drinkable by adding 1 to 2 ounces of the chlorinated lime to every 
65 gallons, and standing the solution aside for some hours till pre- 
cipitation and exposure to the air have gone on for some time. 

It should be remembered that the chlorine fumes will bleach most 
dyed goods. The placing of chlorinated lime in saucers about sinks 
and closets is useless, as the amount of chlorine liberated is very 
slight as compared to the volume of air in the room. Where the 
chlorine is concentrated enough to kill germs it will also kill the 
occupant of the chamber. The deodorant effect may be obtained, but 
a bad smell, if it exists, even when overcome by a greater one, is not 
really gotten rid of. The officinal preparations of the B. P. are, 
Liquor Calcis Chlorinatce and Vapor Chlori, 



CHLOROFORM. 119 



CHLOROFORM. 



Chloroform was originally discovered by Guthrie, of Sackett's 
Harbor, New York, but first brought into medical use by Simpson, 
of Edinburgh. It is a clear liquid of an exceedingly hot, burning, 
sweetish taste, of a rather agreeable odor, and is very volatile in the 
presence of ordinary air. 

There are two kinds of chloroform, the purified [Chloroformum 
Purification, U. S.), and commercial chloroform (Chloroformum 
Venale, U. S., Chloroformum, B. P.) 

Physiological Action. — Locally applied to the skin chloroform 
may produce some tingling and burning, even if evaporation be not 
interfered with. If it is confined under a watch-glass on the skin it 
will cause a blister and act as a counter-irritant. 

When inhaled, chloroform produces a sensation of warmth in the 
mouth and throat, a feeling of relaxation and, finally, unconsciousness. 
The respirations are at first full and deep but soon become more rapid 
and less full. The pulse is also somewhat stronger and fuller for a 
short interval but then fails in strength and becomes more rapid. The 
irritation produced in the air-passages by its inhalation is very slight 
and no primary arrest of respiration ensues, as is generally seen after 
ether is first given. The pupils are at first slightly dilated but con- 
tracted during anaesthesia. If the pupils dilate during the use of 
chloroform, after the contraction just named, danger is imminent and 
death may occur. In some persons the first effects are to produce 
violent struggles, and there is danger in trying to overcome these 
struggles by pushing the drug very rapidly. This is particularly so 
in athletes and drunkards. Total muscular relaxation should never 
be caused by the drug. 

Nervous System. — Chloroform first affects the brain, then the 
sensory part of the spinal cord, then the motor tract of the cord, then 
the sensory paths of the medulla oblongata, and finally the motor 
portion of the medulla, thereby producing death from failure of re- 
spiration unless the heart has already succumbed to the drug. On 
the sensory and motor nerves, when locally applied, it acts as an 
irritant and anaesthetic. Upon these trunks, by inhalation, it has 
little effect. 

Circulation. — Chloroform may, during the first few moments 
of its inhalation, have a slight stimulant effect on the circulation, 
but its dominant effect is depressant, and it is in overdose a powerful 
cardiac poison, absolutely paralyzing the contractility of the heart 
muscle. It generally kills by heart-paralysis. 

Blood. — Upon the blood in the body chloroform has little or no 
effect when it is inhaled. Shaken with chloroform in a bowl out- 
side the body the blood becomes scarlet in hue. 



120 DRUGS. 

Respiration. — In small amount chloroform may not be a respir- 
atory depressant, but in full dose it certainly acts as such. Death 
from chloroform may be from either respiratory or cardiac failure, 
often from both. 1 

Temperature. — Chloroform by inhalation distinctly lowers the 
bodily temperature, probably by aiding in the dissipation of heat and 
by its action on the nervous mechanism of heat production. 

Elimination takes place by the lungs and by the kidneys, and 
goes on very rapidly owing to the great volatility of the drug. 

If large amounts are eliminated by the kidneys these organs are 
apt to become irritated and inflamed. 

Antiseptic Power. — Salkowski has investigated, after Koch's me- 
thods, the degree to which chloroform-water acts upon microorgan- 
isms. He has used chloroform for some years to prevent urine 
decomposing before he had time to examine it. Chloroform pre- 
vents all fermentations which depend upon the growth of micro- 
organisms — e. g., alcoholic fermentation, ammoniacal fermentation 
of urine, conversion of hippuric acid by fermentation into benzoic 
acid and glycocol, lactic fermentation, and the putrefaction of albu- 
mins, but it has no action on those processes caused by unorganized 
ferments, as ptyalin, pepsin, etc. 

Chloroform-water may be used to prepare solutions for subcuta- 
neous injections and given internally in diseases of the digestive 
organs depending on the presence of microorganisms — among others, 
cholera. Possibly the benefit that many patients derive from stomachic 
mixtures containing chloroform-water as a vehicle is due to its destruc- 
tive action on various microorganisms. Salkowski gave a dog 200 
cubic centimetres (about 6 J ounces) of chloroform-water with its 
food for four days without producing any ill effect, so that in the 
treatment of a disease like cholera large quantities of chloroform- 
water might be given. It may even be employed as a mouth-wash. 2 

Untoward Effects. — Sometimes in the administration of chloro- 
form the heart or respiration suddenly cease, and in some cases this 
change is preceded by a peculiar shade or cloud which passes over 
the face of the patient. Death often comes suddenly and without 
any warning. If untoward effects appear the anaesthetic must be 
at once withdrawn and artificial respiration resorted to. 3 Injections 

1 For a lengthy criticism and series of experiments proving an error in the conclu- 
sions of the Hyderabad Chloroform Commission see paper by Wood and Hare, Medical 
News, Feb. 22, 1890. 

2 Chloroform -water is to be made by adding 1 fluidrachm of chloroform to 25 ounces 
of distilled water. The mixture is then put in a well-stoppered bottle and shaken 
thoroughly until the chloroform is dissolved in the water. The dose is generally i to 2 
ounces. 

3 While few text-books give any specific directions concerning the practical applica- 
tion of such methods, those that do so force the physician to a method at once dangerous 
and impractical, for the directions usually given are to place the positive pole on the 
phrenic nerve as it crosses the anterior scalene muscle at the root of the neck, the nega- 
tive pole being pressed against the lower margin of the ribs, a rapidly interrupted cur- 



CHLOROFORM. 121 

of ether and hot brandy should be given beneath the skin, and the 
poles of a battery with a rapidly interrupted current swept over the 
body, but not held over the phrenic nerve and diaphragm. The 
patient must be held head downward, to cause the blood to flow to 
the brain, and external heat be applied. Atropin, strychnine, and 
digitalis may be used to stimulate the heart and respiration. 

The measures adopted for resuscitation should not be stopped for 
at least one hour, as persons have recovered as long as this after an 
accident from chloroform. 

Therapeutics. — The first and most important use of chloroform 
is as an anaesthetic, and at this point we come to a question which 
has been a matter of contention for many years between different 
sections of the medical profession, as to whether its use is very dan- 
gerous or not. In the southern and western parts of the United 
States chloroform is nearly always used, but in the eastern and 
northern portions it is rarely employed. Southerners certainly seem 
to stand chloroform better than northerners or those living on 
the Atlantic coast. It is impossible to go into a general discussion 
of the question here ; suffice it to state that even the most enthu- 
siastic supporters of the use of chloroform confess that it is a more 
dangerous drug than ether, if carelessly used, and while the ad- 
vantages of chloroform are many, this one great disadvantage 
overshadows them all. The advantages are its more agreeable 
odor and lack of irritation to the air-passages, owing to the small 
amount used to cause anaesthesia, the fact that it is less apt to 
be followed by nausea and vomiting, the rapidity of its action, and 
the small bulk which has to be carried by the surgeon. Its disad- 
vantages are the possibility of its suddenly killing the patient by 
sudden cardiac or respiratory paralysis from which there is no relief, 
and the powerfully depressing influence which it exercises over the 
respiratory centres. Owing to these facts the following rules may be 
laid down in regard to chloroform and ether : 

1. Chloroform may be used whenever a large number of persons 
are to be anaesthetized rapidly so that the surgeon may pass on to 
others and save a majority of lives, although it endangers a few, as 
on the battle-field and where only a small bulk of anaesthetic can be 
carried. 

2. Its employment is indicated in cases of Bright' s disease suffer- 
ing from injury requiring the surgeon's attention, owing to the fact 

rent being used with the purpose of causing contraction of the diaphragm by the direct 
action of the electricity upon the nerve. Even theoretically this is a possible source of 
danger, and practically we have proved danger to be an ever-present fact under its use. 
The cardiac inhibitory nerves run so closely to the phrenic fibres, and respond so readily 
to electrical stimulation, that it is hard to imagine how they can escape stimulation if 
a current be used of sufficient strength to excite the phrenic nerves near by. By prac- 
tical experiment we have proved that inhibition of the heart may not only be possibly 
brought about by this method, but that it is nearly impossible to avoid its production if 
the phrenics are to be reached at all. 



122 DRUGS. 

that anaesthesia may be obtained with so little chloroform that the 
kidneys are not irritated, whereas ether, because of its large quantity, 
would irritate these organs. Quantity for quantity, ether is, of 
course, the less irritant of the two. 

3. In cases of aneurism, or great atheroma of the bloodvessels, 
where the shock of an operation without anaesthesia would be a greater 
danger than the use of an anaesthetic, chloroform is to be employed, 
since the greater struggles caused by ether and the stimulating effect 
which it has on the circulation and blood-pressure might cause vas- 
cular rupture. 

4. In children or adults who already have bronchitis, or who are 
known to bear ether badly, or, in other words, have an idiosyncrasy 
to that drug, chloroform may be employed. 

5. Persons who struggle violently and who are robust and strong 
are in greater danger from the use of chloroform than the sickly 
and weak, probably because the struggles strain the heart and thereby 
weaken it. 

Above all things it is necessary to remember the fact that a person 
having taken chloroform twenty times before does not show he is 
not in danger on taking it the twenty-first time, and it is also to be 
borne in mind that many of the sudden deaths from chloroform have 
occurred during the first inhalation of the drug before consciousness 
has been lost, and, therefore, when an accident was least expected. 

When chloroform is given it should be poured to the amount of a 
teaspoonful upou a folded napkin or towel, and the cloth should then 
be held about three to six inches from the mouth and nose, so that 
the vapor may be thoroughly mixed with air in the proportion of 95 
per cent, of air to 5 of vapor. The administration must be gradual, 
as " pushing " the anaesthetic is dangerous. 

Chloroform inhalations have been recommended in excessive 
chorea and in puerperal convulsions, and are, of course, of great 
service in the reduction of hernia, owing to the muscular relaxation 
produced. Sometimes a few whiffs will put a nervous patient asleep. 
For some unknown reason parturient women seem able to take chlo- 
roform with more safety than men or women in an ordinary condition. 

Chloroform, when taken internally by the mouth, causes a sensa- 
tion of warmth in the stomach and a hot, burning taste about the 
lips and buccal mucous membrane. In overdose it can and has pro- 
duced death when taken in this manner. Although rarely used in 
internal medicine, chloroform in the form of the spirit of chloroform 
(Spiritus Chloroformi), is useful in cough mixtures, which are given 
to persons having an irritative cough, and in cases where, through 
nervousness or other cause, tickling in the throat or bronchial tubes 
keeps the patient continually in a state of unrest. (See Bronchitis.) 

In severe whooping-cough a few drops may be poured on the hand 
of the attendant and held before the child's face. While the child 
may at first dislike the odor of the drug the relief given soon teaches 



CHLORODYNE. 123 

him its value, and he will ask for it when he feels the attack 
coming on. 

In gastric or intestinal flatulence 1 or 2 drops of pure chloroform, 
or 10 to 20 drops of the spirit of chloroform, will give relief. In 
serous diarrhoea combined with astringents and opium the spirit of 
chloroform is most useful, provided that the irritating cause is first 
removed. In renal or hepatic colic a few inhalations, not sufficient 
to disturb consciousness, will give not only temporary but permanent 
relief. Hypodermic injections of 10 to 15 drops, reaching down 
to a painful sciatic nerve, have been recommended by Bartholow. 
Rubbed on the chest in the form of chloroform liniment it will pre- 
vent asthmatic attacks, but it ought to be most carefully inhaled in 
this state, because of the strained condition of the right side of the 
heart. In drachm doses chloroform has been used as a remedy for 
tapeworm, but ought never to be so employed. 

In liniments of a stimulating character chloroform is very useful 
over muscles affected by soreness and stiffness, as in lumbago and 
gout, and these liniments may also be used in neuralgias for their 
local anaesthetic effect. 

Administration. — The officinal preparations of chloroform are a 
liniment (Linimentum Chloroformi, U. S. and B. P.), a spirit (Spiritus 
Chloroformi, 77. S. and B. P.), the dose of which is 20 minims to 1 
fluidrachm ; and a mixture {Mistura Chloroformi, U. S.), composed of 
chloroform, camphor, yolk of egg, and water, given in the dose of 2 
to 4 fluidrachms. The B. P. recognizes, besides those given, the 
following preparations : Aqua Chloroformi, given in the dose of J to 
2 fluidounces ; Tinctura Chloroformi Composita, composed of rectified 
spirit, chloroform, and cardamoms, dose 20 to 60 minims ; and 
Tinctura Chloroformi et Morphince, dose 5 to 10 minims. 

Ohlorodyne. 

Chlorodyne is a preparation used to a very large extent by the 
English for serous diarrhoeas or cramps in the stomach. Even in 
England its constitution varies considerably, but the most commonly 
used formula is as follows : 

ft. — Morphinse hydrochlor gr. viij. 

Aq. dest . f'gss. 

Heat together, and as soon as the morphine is dissolved and the liquid cooled, 
add 

Acid, hydrochlor. dil. . . . . . . f^ss. 

Chloroform ........ f^jss. 

Tr. cannabis indicse . . . . . . fgj. 

Acid, hydrocyanic, dil. . . . . . Ttlxij. 

Alcohol f^ss. 

01. menth. piperit TTLxij. 

Oleoresin. capsici lt[j. 

M. — S. 5 to 15 drops for an adult, in water. More than this quantity is 
dangerous. 



124 DRUGS. 



CHROMIC ACID. 

Chromic Acid (Acidum Chromicum, U. S. and B. P.) is not a 
true acid, but an an hydrate, and occurs in the form of brilliant red 
crystals which are deliquescent and possess a sour, metallic taste. It 
should never be mixed with sweet spirits of nitre, strong alcohol, or 
glycerin, as under those circumstances it may explode. 

Therapeutics.— Chromic acid is used solely as a caustic for the 
removal and destruction of groioths on the shin or mucous membranes. 
The solution, resulting from its deliquescence on exposure to the 
air, may be employed by means of a glass rod, if a very severe 
action is needed. 

Dr. J. ¥m. White has recorded a death from the application of 
this acid to a large number of condylomata about the buttocks and 
vulva. Where the drug has been swallowed the patient should be 
treated for the gastro-enteritis, and dilute alkalies and lime-water be 
used, as well as emetics and demulcent drinks. 

If a superficial action is desired, a solution containing 100 grains 
to the ounce of water is sufficient, and for small warts and similar 
growths this will be found strong enough. 

Liquor Acidi Chromici, B, P., is composed of 1 part acid to 3 of 
water. 

CHRYSAROBIN. 

Chrysarobin (Chrysarobinum, U.S. and B. P.) is a mixture of the 
proximate principles derived from a powder found in the wood of 
the tree Andira Araroba, which was originally used for medicinal 
purposes in Brazil. In the East Indies it is called " Goa powder." 
Chrysarobin is not chrysophanic acid, but is a yellow, tasteless 
powder, soluble in solutions of alkalies, acids, and ether. 

Therapeutics. — Chrysarobin is given internally in the dose of -|- of 
a grain in psoriasis and parasitic diseases of the skin, but more 
commonly is employed externally in the form of the officinal oint- 
ment (Unguentum Chrysarobini, U. S. and B. P.), which is too 
strong for direct use, and should be mixed with 4 or 5 parts of 
benzoated lard before application to the skin. As the ointment 
stains the skin a dark-brown it ought not to be used on the face, 
although the discoloration may be removed by a weak solution of 
chlorinated lime. 

CIMICIFUGA. 

Cimicifuga ( U. 8.) This drug is derived from Cimifuga Bace- 
mosa, otherwise known as black cohosh or black snake-root. It con- 



CINCHONA. 125 

tains a resin and a volatile oil, upon which its medicinal powers are 
supposed to depend. It is officinal in the B. P. as Cimidfugce 
Mhizoma. 

Physiological Action. — In large doses cimicifuga paralyzes the 
sensory side of the spinal cord, and in consequence lowers reflex 
activity. It has no effect on the nerves and muscles. On the circu- 
lation the drug acts by depressing the heart and vaso-motor system. 
Death is due to respiratory arrest. 1 In small dose it is a cardiac 
stimulant. In overdose it may produce frontal headache. 

Therapeutics. — Cimicifuga is, after arsenic, the best remedy Ave 
have for chorea, particularly if debility is present, when it should be 
used with careful attention to the bowels and accompanied by iron. 
In chronic bronchitis it is asserted to be of value, and in rheumatism 
of a subacute or chronic type sometimes gives relief. 

Cimicifuga has been highly praised in neuralgia, particularly of 
the ovarian type, and in amenorrhoea, subinvolution, and tenderness of 
the womb. In women who state they cannot step off a step without 
paining or hurting the uterus or ovaries cimicifuga often gives relief. 
Some writers assert that it is an efficient and active heart tonic in 
cases of fatty and irritable heart where digitalis fails. There can be 
no doubt that it is a powerful uterine stimulant, and it ought not to 
be used in pregnancy for fear of abortion. By reason of this power 
it may be employed instead of ergot, and is better in some cases, 
because it produces normal, not tonic, contractions. In headache, 
arising from overstraining of the eyes and study, cimicifuga is said 
to do good. 

The drug is officinal in the form of the fluid extract (Extractum 
Cimicifugce Fluidum, U. S. and B. P.), the dose of which is 10 to 30 
drops, or even 1 drachm, and the tincture (Tinctura Cimicifugce, U. S. 
and B. P.), the dose of which is 1 to 2 drachms. 



CINCHONA. 

Cinchona, U.S., is a name applied to the bark of all the trees 
belonging to the genus Cinchona, provided they contain as much as 
2 per cent, of the alkaloid quinine. The same barks are included 
under the name of Cinchona Cortex in the B. P. There are 
thirty-one species of this genus, but only a comparatively small 
number can be included in the list of 2 per cent, of obtainable 
alkoloid. These are the Cinchona Calisaya, or Cinchona Flava, 
U. S., which contains the most quinine, the Cinchona Condominea, 
Cinchona Micrantha, Cinchona Succiruba, or Cinchona Rubra, US., 

1 See Therapeutic Gazette, 1887, p. 731, for research of Dr. E. Hutchinson upon this 
drug. 



]26 DRUGS. 

Cinchona Rubra Cortex, P. P., and Cinchona Pitayensis. The first 
is called yellow bark, the second pale bark, the fourth red bark. The 
alkaloids of the quinine series derived from these barks are quinine 
or quinina, quinidin or quinidina, and quinicin, which is an arti- 
ficial alkaloid. Of the cinchonin series we have cinchonin (Cin- 
chonina, U.S.), cinchonidin (Cinchonidinw Sulphas, U. S. and P.P.), 
and cinchonicin, which last is also an artificial alkaloid. Besides 
these alkaloids we have present tannic and kino-tannic acids and 
other inert and useless substances. 

As quinina is the most important of the group, and as its physio- 
logical action is virtually identical with the rest, whatever is here 
said refers to quinine unless otherwise stated. 

Physiological Action. — When quinine is taken in overdose it 
causes ringing in the ears, dizziness, disorders of the taste and smell, 
disturbance of vision in some cases, and fulness in the head. Deaf- 
ness often comes on and is generally, with the roaring in the ears, the 
most pressing symptom. Headache is not uncommonly seen. 

Nervous System. — Upon the cerebrum quinine acts as a stimu- 
lant, and, finally, as a congestant, if given in excessive dose. It 
poisonous doses are used iutense cerebral congestion ensues, and, 
finally, unconsciousness comes on. On the spinal cord the drug first 
causes a decrease in reflex action by stimulating Setschenow's reflex 
inhibitory centre, and, finally, by depressing the spinal cord and 
nerves. The latter changes only occur after poisonous doses. 

Circulation. — If quinine, even in small amount, be injected into 
the jugular vein of a dog, so that it comes in concentrated form to 
the heart, cardiac paralysis will result. If this does not occur the 
drug decreases pulse force, rate, and arterial pressure. In minute 
doses the drug acts as a general stimulant to the entire body and so 
supports the circulation. 

Blood. — The blood after poisonous doses is more coagulable than 
normal, but in medicinal amounts no such effect is produced. The 
movement of the white blood-cells through the walls of the capil- 
laries in inflamed areas is checked by large doses of quinine, and 
medicinal amounts increase the number of the red blood-corpuscles 
very materially. It is said that quinine prevents the oxygen-bear- 
ing powers of the corpuscles, but this probably does not occur from 
medicinal doses. 

Respiration. — Upon respiration quinine acts as a slight stimu- 
lant in small doses, but as a marked depressant in poisonous amounts, 
death being most commonly due to this cause if it be taken by the 
stomach. 

Temperature. — Quinine lowers bodily temperature in health 
very little if at all, and in fevered states its influence is governed by 
the cause of the fever. Thus in malarial fevers it is very powerful. 
In fever before crisis quinine is of little service, but in that after 
crisis it causes a rapid fall. 



CINCHONA. 127 

As an antiseptic quinine has considerable power. 

Quinine is absorbed only from the stomach, as it is precipitated 
by the alkaline juices of the intestine. 

Kidneys, Elimination, and Tissue- waste. — Quinine escapes 
through the body chiefly through the kidneys, although much of it 
is destroyed by oxidation in the liver and tissues. In the urine it is 
found as quinine and as dihydroxyl quinine. 

Upon tissue-waste quinine acts as a depressant and decreases the 
elimination of nitrogenous materials. 

Poisoning and Untoward Effects. — Poisoning so seldom occurs as 
the result of the ingestion of overdoses of quinine that untoward 
effects is the best term to qualify the disagreeable symptoms which 
sometimes come on in persons having an idiosyncrasy to the drug, 
and who are in reality poisoned by small doses. In these cases sud- 
den, complete, but temporary blindness often is met with. In other 
instances, complete deafness asserts itself, due to congestion of the 
middle ear, while skin eruptions, generally of the nature of erythema, 
are not rarely seen. After lethal doses haemorrhage into the middle 
ear may be found, and severe epistaxis may ensue after so small a 
dose as 4 grains. The buzzing in the ears can generally be put 
aside by 10 grains of bromide of sodium or a little ergot. 

Therapeutics. — This drug is employed in medicine to fulfil three 
great offices, although its influence in other directions is hardly less 
powerful. These are as an anti-periodic or anti-malarial, as a tonic 
possessing peculiar virtues, and as a stimulant to the parturient 
uterus. 

In malarial fever it is the best remedy we have, as a prophylactic 
and cure, and should be given in doses which are indicated by the 
state of the patient. (See Malarial Fever.) It should always be 
preceded by a purge having an hepatic action, if this is possible. 
This is particularly so in bilious or remittent fever. The drug should 
be given in hourly doses or in one or two large doses in such a way 
that its influence is fully felt, not at the time of the expected parox- 
ysm, but about an hour or thirty minutes before that time. If the 
paroxysm is near at hand the drug should be given in solution, bitter 
though it be, in acidulated water. 

As a prophylactic against malaria the dose should be 2 to 4 grains, 
or more, three times a day. 

In pernicious malarial fever quinine should be given by the mouth, 
the rectum and hypodermically, as much as 60 to 70 grains being 
used at a dose. In brow ague or malarial neuralgia quinine acts 
often most usefully, and this is also true in some cases of ordinary 
nerve-pain not dependent upon a specific disease. 

In the fever of typhus or typhoid fever quinine will be found infe- 
rior to the new antipyretics, even when given in very large dose, and 
rarely ought to be used. It will seldom cause a fall of temperature 



128 DRUGS. 

before crisis or lysis, but will aid in the fall very actively after these 
changes have occurred. 

As a tonic quinine is not only a simple bitter but also seems to 
have a direct effect in increasing the number of the red blood- 
corpuscles. The tonic doses should be 2 grains three times a day. 

In parturient women the drug undoubtedly aids in the expulsion 
of the child by stimulating the uterine contractions, either by a direct 
influence over the uteres, or by supporting the system. Its use is 
particularly indicated in cases where the pains have ceased because 
of exhaustion from prolonged labor. The dose should be 10 to 20 
grains dissolved in water in order that immediate absorption may 
occur. Quinine will not of itself cause abortion. 

In the lobar pneumonia of children quinine should be used in sup- 
positories in the dose of 2 grains three times a day. 

In cases where prolonged mental or physical strain is to be under- 
gone quinine in the dose of 2 to 4 grains will often prevent ex- 
haustion and support the system. 

Used in solution in the form of a spray by the atomizer, quinine is 
of undoubted service in whooping-cough, and will often prevent the 
spread of the disease to other children if they be subjected to its use. 
The solution should contain from 1 to 2 grains to the ounce and be 
employed every few hours. It is well to remember that quinine is 
not tasted by the tip of the tongue, but is tasted by the back portion. 
The tip of the atomizer should therefore be carried well back of the 
root of this organ and a 1 per cent, solution of cocaine painted over 
the dorsum of the tongue in cases where the disagreeable effect of the 
quinine is objected to very strongly. The same solution of quinine 
used, by means of an atomizer, in colds in the head and foetid sore- 
throat is often of service. 

Administration. — Quinine ought never to be given in solution if 
it can be avoided, because of its disagreeable taste. In adults and 
children it should be used preferably in small capsules and in pills, 
which may be gelatin- or sugar-coated. Care should be taken that 
the gelatin is thin and the sugar not hardened by age, for if the pill 
escapes into the intestine the quinine is precipitated and not absorbed. 
If the case is that of a child too young to take a pill, the drug may be 
given in the following manner without tasting very disagreeably : 

R. — Quininae bisulph gr. xvj. 

Ext. glvcyrrhiz. ....... gj. 

Syr. rubi idsei f^ij- 

M. — S. A teaspoonful t. d. or oftener for a child of three. 

In some cases quinine chocolates may be used, but generally even 
with these the after-taste of quinine is well marked. In other cases 
quinine may be used in suppository in the dose of 2 to 3 grains, 
care being taken that irritation of the rectum does not ensue. 

For hypodermic use the bisulphate of quinine (Quinince Bisulphas, 



CINNAMON. 129 

U. 8. and B. P.) should be most commonly used, as it is soluble in 
about 8 quarts of water, and to this solution should be added a little 
tartaric acid to prevent precipitation of the drug in the alkaline juices 
of the connective tissues before it can be absorbed. The tartaric acid 
should be present in the proportion of about 1 grain to each 5 grains 
of the quinine. 

The hydrobromate of quinine (Quinince Hydrobromas, U. 8.), the 
solubility of which is about 1 to 16 of water, may be used in this 
manner, as may also the bimuriate of quinine and urea, which, how- 
ever, is scarcely more than half as strong in quinine as the other 
salts. Valerianate of quinine (Quinince Valerianas, U. S.) is given 
in 1 to 2 grain doses, and the hydroehlorate (Quinince Hydrochlor as, 
U. 8. and B. P.) in the dose of 1 to 10 grains. 

The dose of quinidine sulphate (Quinidince Sulphas, U. 8.) is about 
twice that of quinine, as is also that of cinchonine sulphate (Cincho- 
nince Sulphas, U. 8. and B. P.) and cinchonidine sulphate (Cinchoni- 
dince Sulphas, U. 8. and B. P.). 

The liquid preparations of cinchona are the infusion (lnfusum Cin- 
ehonce, U. 8.), dose a wineglassful ; the tincture (Tinctura Cinehonce, 
U. 8. and B. P.), one to two teaspoonfuls ; and the compound tinc- 
ture (Tinctura Cinehonce Composita, U. 8. and B. P.), a teaspoonful 
to a tablespoonful. The last is a most efficient and elegant bitter 
tonic in debility and convalescence from low fevers. It is too weak 
to be used in malarial poisoning. The other liquid preparation is 
the fluid extract (Extractum Cinehonce Fluidum, TJ. 8.), dose 5 to 15 
drops. A solid extract (Extractum Cinehonce, U. 8.) is also officinal 
in the dose of 5 to 10 grains. The B. P. preparations not officinal 
in the U. 8. P. are as follows : Decoctum Cinehonce, dose 1 to 2 
fluidounces ; Extractum Cinehonce Liquidum, dose 5 to 10 minims ; 
lnfusum Cinehonce Aeiclum, dose 1 to 2 fluidounces; Tinctura Quinince 
Ammoniata, dose J to 2 fluidrachms ; Vinum Quinince, dose J to 1 
fluidounce. 

Contra-indications. — Quinine is contra-indicated in gastritis, cyst- 
itis, meningitis, epilepsy, cerebritis, middle ear disease, and in those 
cases which have an idiosyncrasy to its action. 



CINNAMON. 

Cinnamon (Cinnamomum, U.S., Cinnamomum Cortex, B.P) is the 
inner bark of the Cinnamomum Zeylanieum, a native of Ceylon, or 
of the species indigenous to China. It contains a volatile oil and 
tannic acid. In overdose it acts as a soporific, and kills by failure 
of respiration. 

Therapeutics. — Cinnamon is used, as are all the drugs of its class, 
for flavoring, as a carminative, and as an intestinal stimulant in 

9 



130 DRUGS. 

serous diarrhoeas. It has the peculiar power of acting as a haemos- 
tatic in uterine haemorrhage where the flow is oozing and not active, 
thereby differing from the other volatile oils, with the exception of 
that of erigeron. 

Administration. — The dose of the oil {Oleum Cinnamomi, U. 8. 
and B. P.) is 1 to 5 drops ; of the water ( Aqua Cinnamomi, U. 8. 
and B. P.) a wineglass fill or less; of the spirit (Spiritus Cinnamomi, 
U. 8. and B.P.) 5 to 30 drops ; of the tincture [Tinctura Cinnamomi, 
U. 8. and B. P.) J to 1 drachm. Under the name of Pulvis Aroma- 
ticus, U. 8. (Pulvis Cinnamomi Compositus, B. P.), a carminative 
powder, consisting of cinnamon 35 parts, nutmegs 15 parts, carda- 
moms 15 parts, and ginger 35 parts, is officinal. It is useful in the 
flatulence of adults and children. The latter should take about 10 
grains, an adult 30 grains. 



CITRATE OF POTASSIUM. 

Citrate of Potassium (Potassii Citras, U. 8. and B. P.) is a white, 
granular, deliquescent salt, almost neutral in reaction and very soluble 
in water. It is by far the most agreeable of all the salts of potassium 
to the taste. In the early stages of bronchitis it is of the greatest 
value combined with ipecac (see Bronchitis), and it is also useful as an 
alkaline diuretic. In bronchitis the dose should be 20 grains every 
four hours, and also in urinary incontinence from concentrated urine 
the dose should be equally large. 

Under the name of neutral mixture (Mistura Potassii Citratis, 
U. 8.), made by adding to 1 pint of lemon juice enough bicarbonate of 
potassium to neutralize it, we have a useful febrifuge drink in fevers, 
particularly those of childhood. The dose is J to 1 ounce every 
few hours. 

Liquor potassii citratis, U. S., is made in the same way, except that 
citric acid is substituted for the lemon juice (citric acid 720 grains, 
potassium bicarbonate 960 grains, and water 24 ouuces). 

Neutral mixture is the better of the two, but more expensive. A 
very refreshing and agreeable way of prescribing this drug is in the 
form of " effervescing draught," made by mixing two solutions which 
are prepared as follows : 1. Lemon juice and water, equal parts, 
enough to make 4 ounces. 2. Bicarbonate of potassium 1 drachm, 
and water 3 ounces. These solutions are to be mixed in the quanti- 
ties desired and taken while effervescing. If lemon juice is not at 
hand, a solution of citric acid of the strength of 2 drachms to 4 
ounces of water should be employed. 



CLOVES. 131 



CITRIC ACID. 



Citric Acid (Acidum Citricum, U. S. and B. P.) is chemically 
identical with the acid of the lemon, but has not identical influences 
over the body with lemon-juice. 

Not only does the lemon owe its acidity to this acid, but most of 
the other edible fruits, such as strawberries and raspberries, depend 
upon its presence for their acidity. 

Therapeutics. — Citric acid is used in scurvy or scorbutus as a pro- 
phylactic and cure. For some unknown reason pure lemon-juice 
seems to beuefit these cases more than citric acid itself, and it is, 
therefore, to be preferred to the latter whenever it can be had. In 
order to keep lemon-juice from decomposition on long voyages, it 
should be boiled and poured while hot into bottles until it nearly 
reaches to the cork ; the remaining space is then filled with a thin 
layer of sweet oil and the bottle corked and stood upright, when the 
juice may be kept indefinitely. 

In some cases lemon-juice or lemonade will cause indigestion and 
a sensation of weight in the stomach, particularly in the sick. This 
is due to the presence of soluble irritant albuminoids, which should 
be precipitated by boiling the lemonade, decanting the solution on 
cooling, and leaving the precipitate to be thrown away. If the super- 
natant liquid is cooled and properly sweetened it is equally agreeable 
with the fresh juice and devoid of irritant power. 

In rheumatism, either acute or chronic, citric acid or lemon juice 
may be employed in the dose of 1 to 2 ounces four times a day, well 
diluted. It is also of value in hepatic inactivity and catarrhal jaun- 
dice. (See Citrate of Potassium.) 

The preparations containing citric acid are Syrupus Acidi Citriei, 
U. S., Succus Limonis, B. P., and Syrupus Limonis, B. P. 



CLOVES. 

Cloves (Caryophyllus, U.S., Caryophyllum, B.P.) are the unex- 
panded flowers of the Eugenia Caryophyllata, a plant of the East and 
West Indies. They possess an aromatic odor and the pungent taste 
of a typical spice. They contain a volatile oil {Oleum Caryophylli, 
TJ. S. and B. P.), which is yellow when fresh but very dark colored 
when old. 

Therapeutics. — Cloves, or their oil, are used in medicine for the 
purpose of acting as a carminative. They are also employed in ordi- 
nary flatule nee as a stimulant and tonic to the stomach, to prevent 
griping in diarrhoea and that caused by purgatives, to act as a flavor- 



132 DRUGS. 

ing agent, as a counter-irritant, and, finally, as a parasiticide and 
local anaesthetic. 

Like all volatile oils, this oil is an efficient local application for 
pediculus pubis and similar parasites, and may be used in toothache 
on a pledget of cotton placed in the cavity in a tooth, because of its 
anaesthetic powers. In myalgia or muscular rheumatism it is often 
placed in the liniment used, for its counter-irritant effect. In over- 
dose it acts as a soporific and kills by failure of respiration and 
marked gastro-enteritis. Minute doses of J to 1 drop of the oil in a 
little water will sometimes control excessive vomiting. In addition 
to the oil the B. P. has an officinal infusion, Infusum Caryophylli y 
the dose of which is 1 to 2 fluidounces. 



COCA AND COCAINE. 

Cocaine is the alkaloid derived from Erythroxylon Coca, a shrub 
of Peru and Bolivia. A second alkaloid, known as Ecgonine, 
has entirely different powers. It is to be distinctly understood that 
Erythroxylon Coca is not the same as chocolate or Theobroma Cacao. 
This drug is officinal in the B. P. as Coca and in the U. S. P. as 
Erythroxylon. 

Physiological Action. — Coca, when taken internally, produces 
symptoms identical with those of the alkaloid, namely, a sense of 
exhilaration and pleasure. Often the amount of muscular and 
mental power is temporarily increased. When locally applied to a 
mucous membrane cocaine causes a blanching followed by marked 
congestion. 

Nervous System. — The dominant action of cocaine, when locally 
applied, is to paralyze the peripheral sensory nerves. When taken 
internally it stimulates the brain to an extraordinary degree. If the 
dose be a poisonous one, convulsions of cerebral origin ensue, and are 
clonic in type. 

Upon the spinal cord cocaine exerts comparatively little effect, 
stimulating it in small amounts and depressing it in very large doses. 
The sensory nerves are also paralyzed by enormous doses, either 
when it is directly applied or taken internally. 

Circulation. — Cocaine acts as a stimulant to the heart and cir- 
culation in moderate amounts, but its effects are not marked except 
in poisonous dose. 

Respiration. — The drug acts as a powerful respiratory stimulant,, 
producing in large dose a great increase in the rapidity of the respi- 
ratory movements. 

Temperature. — Cocaine raises bodily temperature to a very ex- 
traordinary degree if given in overdose, this rise being due to an 
increase of heat-production. (Reichert.) 



COCA AND COCAINE. 133 

Kidneys, Elimination, and Tissue-waste. — The drug is 
eliminated by the kidneys, but is chiefly destroyed by oxidation in 
the body. The quantity of uriue passed is increased and the nitro- 
genous elements a little diminished. 

Eye. — Owing to its powerful action as a local anaesthetic, cocaine 
has been used largely in diseases of the eye. The anaesthesia after 
the use of the drug comes on in from one to five miuutes, according to 
the strength of the solution used, and is accompanied by very marked 
dilatation of the pupil. It is important to remember that this dila- 
tation, unlike that produced by mydriatics such as atropine, does 
not paralyze accommodation. The dilatation of the pupil is due to 
a peripheral stimulation of the sympathetic nerve. The drug does 
not cause a forcible mydriasis, and is never used for the prevention 
of adhesions in iritis. 

Therapeutics. — Cocaine hydrochlorate (Cocaince Hydrochloras, 
B. P.) is used as an anaesthetic in the eye in the dose of from 3 to 
5 or more drops of from a 1 to a 4 per cent, solution. The strength 
of 2 and 3 per cent, is perhaps most commonly employed. 

The conditions indicating its use are all operations upon the eye of 
a painful character, be they what they may, and also for the relief of 
pain where an acute inflammation or foreign body is causing suffering. 

The following will be found useful in these states : 

fy. — Cocain. hydrochlor. . . . . . gr. viij. 

Acid, boracic. . . . . . e;r. vij. 

Aq. dest. . ._ fgj. 

M. — S. Use with a dropper in the eye every hour till relieved. 

Cases are recorded in which cocaine has caused permanent corneal 
opacities. 

Where enucleation of the eyeball is to be practised the drug should 
be replaced by general anaesthetics, but cocaine may be used if it is 
injected deeply around the orbit. 

Owing to the density of the mucous membranes of the vagina 
and rectum, cocaine has little effect upon them unless used in 10 per 
cent, solution and profusely applied. In the mouth cocaine may be 
used in cases of stomatitis where a spot is to be cauterized, in pharyn- 
gitis and in soreness and tenderness of the gums. While it gives 
much temporary relief in pharyngitis the subsequent effects are 
often exceedingly disagreeable, the congestion looking more angry 
and being more painful than before. In coryza and, hay fever a 
powder consisting of cocaine, morphine, and bismuth in the proportion 
of one part each of the two alkaloids and five parts of the bismuth 
will often be of service if snuffed up into the nostrils. If cocaine be 
applied to a large nerve-tract amputation of the tributary limb may 
be performed without pain, but so much must be used that there is 
great danger of poisoning the patient. 

Cocaine is generally used at present in cases requiring amputation 



134 DRUGS. 

of the fingers in place of ether. A tight cord should be bound 
around the base of the finger and a 4 per cent, to 8 per cent, solution 
injected into the part, a ligature about the base of the digit being 
used to prevent hemorrhage and the systemic absorption of the drug. 

Internally cocaine, or the fluid extract of coca, may be used as a 
supportive and stimulant in low fevers and cases where great phys- 
ical and mental strain is to be borne. 

It is undoubtedly of service in the opium habit, but if largely 
used changes the patient from a case of morphiomania to a " coca 
fiend/' In the vomiting of pregnancy and other forms of excessive 
emesis it is of great service by depressing the sensory nerves and 
thereby decreasing the irritability of the stomach. The dose of the 
fluid extract {Extractum Erythroxyli Fluidiim, U. S.) is from J to 2 
drachms. That of cocaine from J to 1 grain. The B. P. preparations 
are Extractum Cocw Liquidum, dose, J to 2 fluidrachms, and Lamellce 
Cocaince, each disc containing y-J-g- grain of cocaine hydrochlorate. 

Untoward Effects. — Sometimes loss of speech, blindness, nausea 
and vomiting, syncope and unconsciousness have followed the in- 
ternal use or local application of the drug. Epileptiform convul- 
sions have also been noted, while the circulation and respiration have 
been disordered in every possible manner. Curiously enough a large 
number of cases of severe poisoning have followed the injection of 
cocaine into the urethra in cases of gonorrhoea and stricture. 



COD-LIVER OIL. 



Oleum Morrhuce, U. S. and B. P., is a fixed oil obtained from the 
fresh livers of the Gadus Morrkuce or cod fish. There are several 
species of cod from which the oil is obtained other than the one named, 
but this is the chief source of supply. The oil is pale or dark, accord- 
ing to its degree of freedom from foreign materials. Although the 
paler oils are generally prescribed, there can be little doubt that the 
darker ones are more medicinally active. The most prominent in- 
organic constituents of the oil are iodine, bromine, sulphuric and 
phosphoric acids. It also contains more or less of the biliary salts. 

Physiological Action. — Cod-liver oil depends on a number of sub- 
stances for its peculiar effect. The iodine certainly exerts certain 
alterative powers and the oil seems readily adapted to digestion and 
absorption. Cod-liver oil passes through animal membranes very 
readily, probably owing to the biliary salts contained in it. 

It aids in the maintenance of bodily temperature by its oxidation 
and causes the deposition of fat in the tissues. The oil also seems to 
influence the blood directly, for clinical observation shows that anae- 
mic persons become healthy looking under its use, and Cutler and 



COD-LIVER OIL. 135 

Bradford have found that this is true by the use of Malassez's blood- 
cell counting apparatus, the red corpuscles being always increased. 
It has been proved by experiment that this oil is more readily oxi- 
dized than any other. 

The belief among physicians that the effects of cod-liver oil are 
dependent upon some peculiar combination of substances has shown 
itself in the attempts of physiological chemists to isolate the combina- 
tion. One of the best results reached is that of Chapoteau, who seems 
to have isolated a crystalline substance containing phosphorus, iodine, 
and bromine. Three to five grains of this represent one drachm of 
the pure oil, and it is certainly of value as a medicament in most 
of the states in which we use the oil itself. In " colds" which 
"hang on" and are not readily gotten rid of, morrhuol is best 
given in capsule or pill. One firm supplies this substance gelatin 
coated. 

Therapeutics. — Cod-liver oil is useful in persons who have no 
tubercular lesion in the lungs or other tissues, but have mucous mem- 
branes which are readily susceptible to disease. This state has been 
called the pretubercular stage of phthisis. In chronic rheumatism the 
drug is often of great service, particularly if the disease is largely 
muscular. Strumous skin lesions depending for their existence not 
only upon scrofulosis but also upon anosmia often yield to its use. 
In enlargement of the lymphatic glands, where they are not undergoing 
acute active suppuration, cod-liver oil does good. This is a state- 
ment requiring explanation. By acute active suppuration is meant 
the early formation of pus or the molecular death of the parts — not 
the slow formation characterized by no active change but represented 
by cold-abscess, or old sores. If the discharge is chronic the oil does 
good. In strumous ophthalmia it is of great service. In advanced 
syphilis cod-liver oil is most useful, and in the early stages of rickets 
it is very valuable. In marasmus, when used by inunction, it is one 
of the best drugs we have. If a few grains of bile-salts, consisting 
of glycocholate and taurocholate of sodium be added to each drachm 
of oil it will be very readily absorbed from the skin. 1 

In sciatica and lumbago and in neuralgia cod-liver oil is of service. 
In emphysema of the lungs it is said to be of great value, and certain 
writers commend its use in gout, although some others have asserted 
that it is of no value. Sometimes old persons whose digestion is not 
disordered and who have no organic brain disease, complain of giddi- 

1 These salts may be bought, or made as follows: To about 300 ec. of ox-gall is added 
nearly thrice that quantity of ordinary alcohol, and the flask shaken thoroughly. All 
the mucus is now precipitated and the supernatant fluid is filtered. To the filtrate is 
added a large excess of sulphuric ether and after a time a plaster-like mass forms at the 
bottom of the vessel, which slowly becomes crystalline. These crystals are now placed 
on a filter paper and washed with a mixture made up of ether and alcohol, equal parts. 
The filter paper is dried and the substances then snen are the taurocholate and glyco- 
cholate of sodium. Having carefully removed these salts from the paper they are ready 
for use. 



136 DRUGS. 

ness. The best remedy for this condition is cod-liver oil and doses ot 
quinine. 

Administration. — Owing to its disagreeable taste and smell most 
patients rebel against using cod-liver oil, but this can, with a little 
persistence, be readily overcome, so that finally the patient may not 
only not object to its use but actually like it. . This is particularly so 
with young children. The secret of reaching this much-to-be- desired 
state lies in the use at first of doses which may be dropped in a tea- 
spoon and the spoon then gently submerged in a glass of milk. The 
oil then floats off in a globule in the centre of the milk in the 
tumbler, and if the milk be rapidly gulped down without the oil 
touching the sides of the glass it will not be tasted. The first gulps 
must be large enough to include the oil. The dose should always 
be taken on a full stomach, and if it be followed by a little pan- 
creatin in five or ten minutes its digestibility will be much increased. 
Other modes of ingestion consist in the placing of the oil in whiskey 
or brandy, in the manner which has been described with milk, and 
this method possesses the advantage that the alcohol aids very dis- 
tinctly in the absorption of the oil. Sometimes a pinch of salt 
placed in the mouth before and after the oil is taken aids in cover- 
ing its taste and in its digestion. (See Indigestion.) Oil of euca- 
lyptus in the proportion of 1 to 100 of the cod-liver oil will cover 
the latter's taste, but many dislike the eucalyptus more than the cod- 
liver oil. The addition of equal parts of glycerin and half to one 
drop of the oil of bitter almonds to each dose is often of service. 
Syrup of bitter orange-peel is one of the best covers to its taste. 
Tomato ketchup has also been used with good results. Chewdng 
a piece of smoked herring before and after taking the oil is of value 
in some cases to disguise its taste. 

Cod-liver oil is most readily digested when given in single nightly 
doses after supper, or after a light meal just before going to bed. After 
a few days it may be given after dinner, and in the course of a week 
after breakfast. If the patient is once nauseated by overdoses it is 
almost impossible to make the stomach retain it. If it cannot be 
digested a drachm of ether aids in its absorption, or a drink of 
whisky or brandy may be used instead. 

A large number of preparations of cod-liver oil are on the market 
in emulsion, pancreatized and purified till they are tasteless. Many 
of the permanent or perfect emulsions have more Iceland moss or 
acacia than oil. The pancreatized emulsions are the best if the oil 
is really present in sufficient quantity to do good, and the mere fact 
of its being artificially digested adds to its value and the possibility 
of putting more oil into the emulsion. Oil devoid of smell is prob- 
ably devoid of medicinal value, as all the peculiar properties have 
been " purified " out of it. Cod-liver oil may be used in capsules 
with great success. 



CO LC HI CUM. 137 



CODEINE. 

Codeina, U. 8. and B. P., is an alkaloid prepared from opium, and 
is often contaminated by morphine. Its physiological action is very 
closely allied to that of its sister alkaloid — morphine — but it is very 
much less powerful. 

Therapeutics. — Codeine has been highly recommended in France 
as a nervous quietant, and in this country in nervous cough or in 
cases where the cough is excessive in bronchitis and phthisis. Under 
these circumstances it should be used in the dose of from J to 2 
grains, generally placed in the syrup of wild-cherry bark. 



OOLCHIOUM. 

Colchicum is the corm (Colchici Cormus, B. P.; Colchici Radix, 
U. S.) and seed (Colchici Semen, U. S. ; Colchici Semina, B. P.) 
of the Colchicum Autumnale, a plant of Europe, containing an alka- 
loid, colchicin, which may be still further changed into colchiceiu. 
While the drug is officinal in the form of the seeds and root the 
former are rarely employed. 

Physiological Action. — Colchicum when locally applied is an 
irritant to the gastro-intestinal mucous membrane, and is a very 
powerful drug. 

According to the studies of one of the writer's students — Dr. 
Ferrer Y. Leon — the drug has little or no effect in moderate dose 
on the nervous system, circulation, respiration or temperature, only 
producing changes in these parts when given in poisonous doses. 

Therapeutics. — The employment of colchicum in medicine centres 
around its use in gout and similar states, such as chronic rheumatism 
or rheumatoid arthritis. Indeed, it is almost a specific in acute gout, 
provided that it be pushed till it causes slight griping or laxity of 
the bowels. Care must be exercised under these circumstances that 
" retrocedent gout " does not occur, owing to the manifestations of the 
disease leaving the toe and going to the internal viscera. In some 
cases iodide of potassium should be used in conjunction with the 
colchicum, particularly is this the case in subacute or chronic cases. 

The use of colchicum in such doses as to cause severe purgation or 
emesis is dangerous, and ought not to be resorted to. 

Poisoning. — The symptoms in poisoning are nausea, griping, agony 
in the belly, purging followed by the passing of thick mucus with 
great and increasing tenesmus, profuse salivation, collapse, and death 
from exhaustion and gastro-enteritis. Bloody purging is almost 
never seen. The poisoning is one of the most painful, slow, and 
hopeless poisonings known, and a man taking as much as an ounce of 



138 DRUGS 

the wine of the root or the seed is almost inevitably doomed to a 
terrible death. Tannic acid may be used as a partial chemical anti- 
dote, and the stomach washed out with emetics and the stomach- 
pump. Opium is to be used to relieve the pain and irritation, and 
oils are to be given to soothe the inflamed mucous membrane. If 
collapse comes on external heat and stimulants are to be used, and 
atropine may prove of service in this stage. 

Administration. — Colchicum ought never to be used in substance, 
but should be employed in the form of wine of the root (Vinum Col- 
chici Radicis, U. S.) in the dose of 10 to 20 drops, although if a 
marked effect is required 30 drops may be used. The extract (Ex- 
tractum Colehici Radicis, U. S.) is given in the close of 2 to 5 drops, 
and the fluid extract (Extractum Colehici Radicis Fluidum, U. S.) in 
the dose of 2 to 4 minims. 

Of the seeds, the tincture (Tinctura Colehici Seminis, U. S. and 
B. P.) is given in 30 to 90 minim doses ; the wine ( Vinum Colehici 
Seminis, U. S.) in the same amounts, and the fluid extract 
(Extractum Colehici Seminis Fluidum, U. S.) in the dose of 2 to 5 
drops. The B. P. preparations besides those given are Vinum Col- 
ehici, dose 10 to 30 minims; Extractum Colehici, dose J to 2 grains; 
and Extractum Colehici Aceticum, dose J to 2 grains. 



COLLODION. 

Collodium, U. S. and B. P., is a solution of gun-cotton in alcohol 
and ether, and is a clear, syrup-like fluid, smelling strongly of ether. 

Therapeutics. — Collodion is used as an air-tight dressing for small- 
wounds and abrasions, and for rendering small dressings waterproof. 
A difficulty in its use consists in the contraction which takes place as 
it dries, drawing and puckering the part sufficiently to cause not only 
discomfort but acute pain. It should be applied with a camel's hair 
brush over the part affected. 

In boils where they are beginning in a small pustule or papule 
with an inflamed zone, collodion painted over the spot will generally 
abort the disease. If the boil has burst this treatment is useless, but 
if it has not the pus should not be liberated, but allowed to become 
inspissated. Thus, by frequent application of a coat or two, the 
trouble eventually disappears. Of course, this rule only applies to 
certain cases, and if pain is caused by the retention of the pus it 
must be evacuated with antiseptic precautions. In smallpox the 
flexible collodion is to be used to prevent pitting. 

In gouty inflammations of the joints an application of collodion 
mixed with iodine, equal parts, will often remove the pain, although 
at first it may be increased. 



COLOCYNTH. 139 



Flexible Collodion. 

Flexible Collodion (CoUodium Flexile, U. S. and B. P.) is made by 
adding turpentine 5 parts and castor oil 3 parts to ordinary collodion. 
It does not contract or become hard, and is generally to be preferred 
to ordinary collodion in the dressing of wounds. 



Styptic Collodion. 

Styptic Collodion (CoUodium Stypticum, U. S.) contains tannic 
acid, and is employed to control small haemorrhages. It is seldom 
used, and is a dirty way of controlling bleeding. 



Cantharidal Collodion. 

Cantharidal Collodion (CoUodium cum Cantharide, U. S.) has been 
referred to under the head of Cantharides. CoUodium Vesicans, B. P., 
is identical with the last preparation, and is used for the same 
purpose. 

COLOCYNTH. 

Colocynthis, U. S., is the fruit of the Citrullus Colocynthis, zl plant 
at present largely grown in all parts of the world. It contains an 
alkaloid colocynthin, a minor alkaloid, and a resin. None of these 
are ever used in medicine. Colocynth causes large watery evacua- 
tions, and may in very large dose produce fatal gastro-enteritis. It 
is officinal in the B. P. as Coloeynthidis Pulpa. 

Therapeutics. — Colocynth is never used alone, but always in com- 
bination with other drugs of its class as a hydragogue cathartic. 

In cases of chronic dropsy or in serous effusions it is generally 
given in the form of the compound extract of colocynth (Extractum 
Coloeynthidis Composition, U. S. and B. P.), which contains 16 parts 
of colocynth, 50 parts of purified aloes, 14 parts of the resin of 
scammony, 6 parts of cardamom, and 4 parts of soap. In the 
dose of 5 to 20 grains this acts as a powerful watery purge. The 
extract (Extractum Coloeynthidis, U. S.) is given with other drugs in 
the dose of 2 to 5 grains as a purge. Colocynth is one of the prin- 
cipal ingredients in compound cathartic pills (Pilulce Catharticce 
Composite^ U. $.). Each pill contains : compound extract of colo- 



140 DRUGS. 

cynth, 1 J grains ; abstract of jalap and calomel, each 1 grain ; gam- 
boge, J grain. 

The preparations of the B. P. not officinal in the U. 8. P. are : 
Pihda Colocynthidis Composita, composed of colocynth pulp, aloes, 
scammony, sulphate of potassium, and oil of cloves, dose 5 to 10 
graius, aud Pilula Colocynthidis et Hyoscyami, dose 5 to 10 grains. 



CONIUM. 

Conium, U. 8. The leaves and fruit of the Conium Maculatum 
are both officinal. The plant grows in Europe and the United States, 
aud contains a resin known as coniin. This drug is officinal in the 
B. P. as hemlock leaves {Conii Folia) and hemlock fruit (Conii 
Zructus). 

Physiological Action. — When conium is taken in very full dose it 
causes weakness and a sense of relaxation, giddiness, staggering, and 
disordered vision, with failure of the circulation. 

Nervous System. — Conium causes paralysis of the motor nerves, 
and, if the dose be extraordinarily large, depression of the sensory 
nerves. Upon the spinal cord it exerts a feeble, depressing influ- 
ence, but has no positive effect, while the fact that mental power 
remains almost up to death shows that the cerebrum escapes its 
influence. 

Circulation. — The action of the drug upon the circulation is 
depressant. It causes at first a fall of arterial pressure, then a rise, 
due to the asphyxia caused by nervo-muscular failure of the respira- 
tory apparatus. Finally a constant fall of pressure takes place. 

Respiration is depressed because of its influence on the nerve- 
trunks supplying the muscles. 

Therapeutics. — Conium holds an unimportant place in the drug- 
list of to-day. 

It has little value except in spasms due to irritation of a nerve- 
trunk, when it may be of service. In spasms of cortical or spinal 
origin other drugs should be used. The powdered leaves or other 
preparations may be smeared over poultices to relieve the pain of 
ulcers and cancers, and it certainly does good in some such instances. 

Administration. — The dose of the abstract (Abstractum Oonii, U. 8.) 
is from J to 3 grains, that of the alcoholic extract (Extractum Conii 
Alcoholicum, U. 8.) is from 1 to 1^ grains, and of fluid extract (Ex- 
tr actum Conii Fluidum, U. 8.) 2 to 6 drops. The dose of the tinc- 
ture (Tinctura Conii, U. 8. and B. P.) is 10 to 30 drops. Coniiueis a 
volatile liquid which should never be used. The dose is about -^ of 
a grain. The preparations in the B. P. made from the leaves are : 
Cataplasma Conii, for external use; Extractum Conii, dose 2 to 6 
grains or more ; 8uccus Conii, dose 30 minims to 2 fluidrachms or 



COPPER. 141 

more ; Vapor Conii, for inhalations ; Pilula Conii Composita, com- 
posed of extract of hemlock and ipecac, dose 5 to 10 grains. 

It is to be remembered that the variability of the drug, so far as 
power is concerned, is very great, so great as to make it unreliable. 

Poisoning. — A prominent symptom of the poisoning is ptosis of 
the eyelids, due to paralysis of the oculo-motor nerves, and the 
staggering and inability to walk already named. Its treatment con- 
sists in the use of strychnine as a respiratory and nervous stimulant, 
the employment of external heat, and the use of cardiac stimulants 
if the circulation fails. The stomach is to be emptied by emetics or 
the stomach-pump before the antidotes are used. 



COPAIBA. 

Copaiba, U. S. and B. P. Copaiba of the U. S. P. is really the 
balsam of copaiba or the oleo-resin of copaiba, and is a clear, trans- 
parent liquid of oily consistency, of a pale yellow T color and a pecu- 
liar odor. 

Therapeutics. — Copaiba is used for the purpose of stimulating the 
mucous membranes of the genito-urinary tract, particularly when 
they are depressed after a period of inflammation, as in the later 
stages of gonorrhoea. Similarly it is employed in subacute and 
chronic bronchitis as an expectorant. In pyelitis, cystitis, and in dys- 
entery it is of value. In dropsy due to slow renal changes it will 
often be of service. 

Administration. — The oil of copaiba {Oleum Co/jaibce, U. S. and 
B. P.) is given in capsule or emulsion, preferably in the former, in 
the dose of 10 to 20 minims two to four times a day. Sometimes it 
is dropped on sugar. 31assa Copaiba, U. S., is made by rubbing 
up the oleoresin with magnesium, but this is a useless and clumsy 
way of using it in the pill form. 

The drug is eliminated in the urine and gives the test for albumin 
with nitric acid. 

In some cases it causes urticaria, which soon ceases on the with- 
drawal of the drug. 



COPPER. 

Cuprum is never used in the form of the metal itself, but as the 
sulphate, which appears in commerce as a blue, clear, somewhat ef- 
florescent salt. It is soluble in four parts of cold water, two of boil- 
ing water, but not soluble in alcohol. 

Physiological Action. — Copper sulphate, when locally applied to a 
mucous membrane, acts as a powerful astringent, or, on the surface 



142 DRUGS. 

of an ulcer, as a mild and superficial caustic. Upon the nervous 
system in cats it acts as a depressant poison when given hypoder- 
mically, finally causing death from respiratory failure. When given 
in overdose by the stomach it causes death by violent gastro-enteritis 
and exhaustion. The symptoms do not generally come on for an 
hour, but consist in burning pain in the stomach, a copperish or me- 
tallic taste in the mouth, followed by vomiting of bluish liquids and 
glairy mucus. With the vomiting purging comes on, the passages 
at first containing the contents of the intestine, and finally mucus 
and blood. Convulsions of an epileptiform character are present 
and constant and profuse salivation is not uncommon. After death 
fatty degeneration of the liver and kidneys has been noticed, and it 
is not at all uncommon for jaundice to appear after the first twenty- 
four hours if the patient survives so long. This jaundice is depend- 
ent upon changes in the blood. The treatment of the poisoning con- 
sists in the primary use of the chemical antidote, which is the yellow 
prussiate of potassium, and the employment of emollient or demulcent 
substances such as sweet oil and white of eggs, followed instantly by 
emetics or the stomach-pump. If emesis and purgation are already 
present, emetics are of course contra-indicated, and counter-irritation 
is to be employed over the stomach and intestines in the shape of a 
mustard plaster of moderate strength, with opium to allay irritation 
and relieve pain. 

Chronic copper poisoning is almost never seen, and although the 
metal is largely used for coloring canned green vegetables, it seems 
to be harmless in such small amounts. 

Therapeutics. — Sulphate of copper (Cupri Sulphas, U. 8., and B. P.) 
in the dose of 5 to 7 grains may be used as a rapidly acting emetic 
which only acts upon the stomach, not the vomiting centre. As it 
is irritant the emetic dose ought not to be repeated, but if emesis 
does not occur the sulphate of zinc or mustard should be used in its 
stead. Indeed, it may be said of sulphate of copper that it should 
never be given as an emetic, except as the chemical antidote in phos- 
phorus poisoning. In pill form it is sometimes given in diarrhoeas 
depending upon ulceration of the bowels. The dose should be \ to 
1 grain combined with opium. 

In some states of the body, particularly in shin diseases of the dry 
type and in persons with tubercular tendencies, copper seems to act 
like arsenic and may be used in minute doses of ^ of a grain or less 
three times a day where arsenic is not well borne. It is said to be 
in small doses a direct stimulant to the tissues and to increase the 
firmness of the flesh and strength of the normal man. 

Injected into the rectum in the strength of 5 to 20 grains to the 
ounce the drug will be found of service in those cases of diarrhoea 
affecting the lower bowel and dependent upon ulceration. 

Locally applied sulphate of copper is of service, in the solid form 
or in powder, in indolent ulcers. In chronic conjunctivitis or in cases 



CREASOTE. 143 

of tinea tarsi — that is, tinea on the margin of the eyelids — the crystal 
may be drawn over the diseased spot, or a weak solution of 1 to 3 
grains to the ounce of water dropped into the eye in subacute con- 
junctivitis. 

In relaxed sore throat, as a gargle, in the strength of 4 grains to 
the ounce, it is often of service. Nitrate of copper (Capri Nitras, 
TJ. S. and B. P.) and acetate of copper {Cupri Acetas, JJ. S.) serve 
the same purpose as the sulphate. 



CREOLIN. 

Creolin is a black fluid derived from soft coal and of the consist- 
ency of syrup. When added to water it forms a white cloud and 
mixes thoroughly, forming an emulsion up to 12 per cent, of the 
drug. 

Therapeutics. — Creolin is used as an antiseptic in the lying-in 
state, as a wash for the hands and for vaginal irrigation. It cannot 
be used as a solution in which to place instruments as it makes so 
opaque a mixture with w r ater as to prevent their being seen. When 
used as a vaginal douche it should be employed in the strength of 2 
per cent. One property which is of value is, that it forms a slippery 
coating over the maternal parts during parturition. In cystitis in the 
female Parvin highly recommends it as a vesical wash in the strength 
of a 1 per cent, solution, or, after the bladder becomes accustomed 
to its use, 2 per cent, solution. According to Kretzschmar and others, 
a solution of 1 to 500 is useful in otorrhoea if used with a syringe, 
and 1 to 100 in nasal ulcers, and 1 to 1000 as a nasal douche in 
rhinitis, with much discharge and the formation of crusts. 

In the eye, Alt has used a 1 to 2 per cent, solution in blepharitis, 
keratitis, and phlyctenular ophthalmia. 



CREASOTE. 

Creasote (Creasotum, JJ. S. and B. P.), as employed in medicine, 
should always be derived from the destructive distillation of beech- 
wood and be called " beech wood creasote/' Much of that sold is 
derived from coal-tar and is far less useful. Chemically creasote is 
almost identical with carbolic acid. It is a powerful antiseptic. 
Beechwood creasote should be of a reddish amber hue and about as 
thick as olive oil. Its physiological action is almost identical with 
that of carbolic acid, and in poisoning by creasote the same antidotes, 
soluble sulphates, should be used 1 (Hare). 

1 See University Medical Magazine, 1889. 



144 DRUGS. 

Therapeutics. — During the past year or two creasote has been 
largely recommended in phthisis and chronic bronchitis, and some of 
the results reached by its use have undoubtedly been of value. It 
has also been inhaled from sponges with great relief, and has been 
even injected into the lungs by the trachea or through the chest-wall. 
(See article on Tuberculosis.) In bronchitis creasote may be placed 
in boiling water and inhaled in the steam. Under these circum- 
stances it at least relieves the fetor of the breath, and often gives 
more rapid relief than any other means in ordinary inflammation of 
the bronchi. The dose is 2 to 5 drops. Applied ou a pledget of 
cotton to the cavity of a tooth it often relieves toothache. 

When given in phthisis the following prescription may be used or 
the drug may be placed upon a Yeo's inhaler and inhaled in that way : 

R. — Creasote (beech wood) . . . . . . f g i i j . 

Tinct. gentian, comp. ...... f.^j. 

Spts. vini rectificati ...... f^viij. 

Vini xerici . . . . . . q. s. ad Oij. 

M.— S. A tablespoonful in a wineglassful of water three times a day. 

Creasote is useless so far as a cure is concerned if tuberculosis is- 
more than incipient, and ought not to be employed if it disorders 
the stomach. The inhalations often give relief in the advanced 
stages of phthisis and decrease the cough, allay the laryngeal dryness,, 
and aid expectoration. 

The preparations of creasote are Aqua Creasoti, U. 8., given in 
the dose of 1 to 3 fluidrachms ; Mistura Creasoti, B. P., dose 1 to 2 
fluidounces ; Unguentum Creasoti, B. P., for local application, and 
Vapor Creasoti, B. P. used by inhalation. 



CROTON OIL. 

Croton oil (Oleum Tiglii, U. $., Oleum Crotonis, B. P.) is an ex- 
ceedingly irritant oil derived from Croton Tiglium, a small tree of 
India. The oil is pale yellow and of a complex character. Applied 
to the skin it is an intense irritant, producing blisters or pustules. 
One drop placed on the tongue acts as a violent watery purge, and, 
owing to the smallness of its dose, it is frequently employed to revulse 
the unconscious, as in cerebral congestion. In delirium it is used for 
the same purpose, and may be given to maniacs. The dose is 1 drop 
placed on the tongue or given in emulsion or in pill. It ought never 
to be used when there is any irritation of the stomach or bowels. As a 
counter-irritant it is sometimes applied over a tender nerve, or in 
bronchitis to the chest, half and half with sweet oil. Thus applied it 
may be absorbed and cause purging. The treatment of poisoning by 
croton oil is that of gastro-enteritis. Linimentum Crotonis is a prepa- 
ration of the B. P., which is employed as a counter-irritant liniment 
on sprains and in muscular rheumatism. 



CYANIDE OF POTASSIUM. 145 



CUBEBS. 



Cubebs (Cubeba, U. 8. and B. P.) are the unripe fruit of Cubeba 
Officinalis, a plant of Java. They consist in wrinkled or rough 
black bodies, about the size of small peas, and have an aromatic, 
pungent taste. They contain a volatile oil, cubebic acid, and cubebin. 
The drug should not be kept in powdered form as it loses its powers, 
but be powdered as needed. Overdoses cause gastrointestinal and 
genito-urinary inflammation. 

Therapeutics. — Cubebs are used in the advanced stages of gonor- 
rhoea where the tendency to a chronic discharge is present. Some 
surgeons have used them in the early stages as an abortive treatment, 
but this is a bad practice. In cold in the head the powdered berries 
may be snuffed up the nostril, provided that the stage of secretion is 
well established. They ought not to be used before this stage. 

Administration. — Cubebs may be given in powder in the dose of 
10 to 60 grains, in the fluid extract (JExtractum Cubebce Fluidum, 
U. 8.) 10 to 30 drops, and in the form of the tincture (Tinctura 
Cubebce, U. 8. and B. P.) in the dose of 10 drops to J an ounce. 

The dose of the oleo- resin (Oleoresina Cubebce, U. 8. and B. P.) 
is 2 to 20 drops. The latter may be given in capsules or emulsion. 
The troches of cubebs (Trochisci Cubebce, V.8.)are used for pharyn- 
gitis of a chronic type. The dose of the oil (Oleum Cubebce, U. 8. 
and B. P.) is 5 to 20 minims. 



CYANIDE OF POTASSIUM. 

Cyanide of potassium (Potassii Cyanidum, U. 8. and B. P.) is used 
in the same way and for the same purpose as hydrocyanic acid. 
(See Hydrocyanic Acid.) The dose is -^ to y 1 ^- of a grain. 

The following prescription may be used in bronchitis or phthisis 
associated with excessive cough : 



1£ . — Potas. cyanid. 

Morph. sulph. . . 
Acid, sulph. arom. 






s:r. j. 


Syr. pruni virg. 
M. S — Teaspoonful three times 


a day, or as follows : 


. q. s. 


fg"j 


^. — Potas. cyanid. . 

Amraon. muriat. . 
Acid, muriat. dil. . 
Elix. calisayse. 
M. S. — Teaspoonful, three times 


a day. 
, 10 


• q- ? - 





146 DRUGS. 



DIGITALIS. 



Digitalis, U. 8., is obtained from the leaves of Digitalis Purpurea, 
or foxglove of the second year's growth. The leaves are officinal in 
the B. P. as Digitalis Folia. It contains a number of alkaloids 
none of which represent its true active principles, which probably 
reside not in one, but in several forms. Digitalin is more nearly the 
active principle than any of the other alkaloids and occurs in two 
forms, the crystalline and amorphous. Both of these often fail. The 
other alkaloids or principles are digitonin, digitalein, and digitoxin. 

Physiological Action. — Digitalis is apt to irritate mucous mem- 
branes which are already slightly out of order, and for this reason 
should not be given by the mouth in cases of gastritis and similar 
states. 

Nervous System. — The action of digitalis over the nervous 
system is only manifested when poisonous doses are used. Small 
toxic doses decrease reflex action by stimulating Setschenow's reflex 
inhibitory centres in the medulla, and finally by depressing the spinal 
cord. Convulsions are sometimes seen as a result of the disorder of 
the circulation at the base of the brain, owing to the disturbed and 
abortive action of the heart. Finally, the motor nerve-trunks them- 
selves are depressed. 

Circulation. — Upon the circulatory system digitalis exerts its 
chief influence. In moderate amounts it increases the pulse force 
and arterial pressure, slow T s the pulse, and increases the size of the 
pulse wave. The increase in pulse force is due to a stimulating in- 
fluence exercised upon the cardiac ganglia and the muscular fibres 
of the heart, the rise of arterial pressure is caused by this increased 
pulse force and pulse volume, and by a stimulation of the vaso-motor 
centre and the muscular coats of the bloodvessels, whereby a con- 
traction occurs in the walls of the arteries and arterioles. The slow 
pulse is produced by stimulation of the pneumogastric centre and the 
peripheral ends of the vagus nerves. The increase in the volume of 
the pulse is due to this influence on the vagi, for the pneumogastric 
nerves being stimulated the diastole of the heart is more full and 
complete and occupies a greater length of time. The result of this 
delay is that the ventricles become thoroughly distended, and on con- 
tracting drive out a much larger wave of blood through the aorta 
than is normally sent out. This is important to remember when 
using the drug in heart-disease and other states. While we do not 
know that the vagi are the trophic nerves of the heart, w T e have a 
large amount of evidence in favor of such a view, and it has long 
been thought that digitalis was not only a heart stimulant, but a 
heart tonic. If the trophic nerves of the heart are stimulated by 
digitalis it at once becomes evident that it is a doubly useful remedy. 

The action of digitalis upon the heart is a double one, in that it 



DIGITALIS. 147 

creates two opposing forces. By the action on the heart muscle it 
steadily strives to cause contraction or systole of the ventricles ; by 
the action on the vagi it equally steadily struggles to produce diastole 
or dilatation of these cavities. In medicinal dose neither of these 
tendencies gets the upper hand, for both are equally excited, so that 
now increased systole occurs, now increased diastole. 

In poisoning, on the other hand, or in instances where overdoses 
have been given, so much stimulation is caused that the heart beats 
now slow, now fast, now strong, now Aveak. Slow when the vagi 
overcome systole, fast when systole overcomes the vagi, strong when 
systole escapes from the inhibitory nerves, weak when the ventricles 
can scarcely contract because the vagi are holding the ventricles 
open. 

If the patient be raised up he may drop dead, owing to the still 
more active disturbance of the balance of power caused by the calls 
for blood due to the erect position, and under these circumstances the 
heart beats so fast that it has not time to get enough blood into it to 
pump anything out, or so feebly that the dilated ventricles are never 
emptied. Finally, a fall of arterial pressure ensues, not because the 
vaso-motor system is depressed, but because the heart cannot pump 
out enough blood to fill the bloodvessels. 

Respiration. — Digitalis has almost no effect on this function. 

Temperature. — Upon the normal bodily temperature digitalis 
has little or no effect in medicinal dose. In poisonous dose it lowers 
temperature. In fever the drug seems to cause a fall of a small 
amount with some constancy, but it can rarely be used for any anti- 
pyretic influence. 

Kidneys, Tissue-waste, and Elimination. — Digitalis has 
almost no effect over the kidney structure itself, and does not to any 
extent stimulate the renal epithelium. The cause of the increased 
urinary flow produced in cardiac dropsy depends upon the removal 
of congestion of the kidneys and the increased arterial pressure 
brought about by the drug. 

Upon tissue-waste digitalis seems to have little effect, and there is 
still some discrepancy in the reports as to the amount of urea cast off 
under its use, some investigators saying it is increased, others that 
it is diminished. 

We do not know how the drug is eliminated, as chemists have 
never been able to find it in the urine. It is probably oxidized in 
the body. 

Poisoning. — The slow, full pulse, followed by the hobbling, dicrotic, 
shuttle-like pulse-beats, and the angry, tumultuous cardiac beat 
against the chest-wall, affords a combination of symptoms character- 
istic of over-action of digitalis. The pulse may be full and slow 
when lying down, but at once becomes irregular on the patient's 
sitting up. 

Often when the patient has by error received too much of the 



148 . DRUGS. 

drug the finger can scarcely note any pulse at the wrist, while the 
ear placed over the heart shows it to be beating wildly, as though it 
would break out of the chest It is important that the weak pulse 
at the wrist be not taken as the only guide as to the state of the 
patient for this very reason. 

As the poisoning progresses vomiting may come on, exophthalmos 
occurs, and a peculiar blue pearliness of the sclerotic coat of the eye 
is seen. Consciousness is generally preserved nearly to the last. 
Death may be put off for days, or occur in two hours, or even less. 
Headache is often a severe symptom. 

Treatment of Poisoning. — Tannic acid is to be given as a 
chemical antidote ; emetics and the stomach-pump are to be used ; 
external heat is to be applied, particularly about the abdomen ; the 
maintenance of a horizontal position must be insisted upon, and the 
use of tincture of aconite, as the physiological antidote, resorted to. 

Therapeutics. — Much unfortunate misunderstanding concerning 
the action of digitalis has arisen, and while some call it a circulatory 
stimulant, others think it a circulatory depressant. The first class 
base their belief on the signs of arterial pressure and cardiac power, 
the others on the fact that it slows and steadies an irritable, rapidly- 
acting heart, while they overlook the other signs. Digitalis is a car- 
diac stimulant, and not a depressant. The quieting of irritability by 
it is the quietness produced by the drink of whiskey or coffee taken 
by the speaker before mounting the platform or the pugilist before 
he enters the ring to steady his nerves and make him firm. If it is 
used to decrease arterial tension its dose must be dangerously large. 
(See Physiological Action.) 

Digitalis is of value in all cases of cardiac disease where the con- 
dition is one in which the heart fails to do its proper amount of work. 
If simple hypertrophy or excessive compensatory hypertrophy exists 
it is harmful. It is of less value in aortic regurgitation than in any 
other lesion, because the prolongation of diastole allows greater op- 
portunity for the blood to fall back into the ventricle. In some 
instances the drug does harm by over-distending the auricle through 
ventricular stimulation, and we can never tell before trying it which 
cases will be so affected. In cases where the heart is irritable, 
palpitation is present, and indigestion is not the cause of the trouble, 
digitalis is of service. (See Heart Disease.) 

In the second stage of pneumonia it is invaluable (see Pneumonia), 
and in exhausting fevers, in small doses, is of great service. In con- 
gestion of the lungs in the typhoid state, it will drive out the blood 
from the part congested and relieve stasis. 

In cardiac weakness from collapse, injury, poisoning or shock digi- 
talis is of service, particularly in aconite poisoning, where it is the 
physiological antidote. Owing to the slowness of its action it should, 
however, be preceded by ammonia and alcohol where the need is 
pressing. In muscarine poisoning it is the antidote. Ci 



ELATERIUM. 149 

As a diuretic digitalis may be used where the kidneys are congested 
and the circulation is sluggish. Where the renal structure is dis- 
eased, other drugs should take its place, or it should be combined 
with more active renal remedies, such as squill or caffein, or in very 
chronic cases with compound spirit of juniper. 

In some cases a cumulative action occurs which consists in the 
failure of the drug to influence appreciably the circulation for some 
days, only to exert all its power suddenly aud produce symptoms of 
poisoning. This is particularly the case where the removal of ascites 
or dropsy takes place by tapping after the drug has been taken for 
a long period. It is thought that the sudden withdrawal of pressure 
causes the absorption of the drug from the juices of the tissues which 
has remained in them heretofore unused. 

The contra- indications to the use of digitalis are atheroma of the 
bloodvessels of a marked type, aneurism, apoplexy, and any state of 
arterial excitement. 

Administration. — The officinal preparations of digitalis are the 
tincture (Tinctura Digitalis, U.S. and B. P.), dose 10 to 20 drops; 
the infusion (Infusum Digitalis, U. S. and B. P.), 1 teaspoonful to 
4 teaspoonfuls ; the fluid extract (JExtractum Digitalis Fluidum, U.S.), 
dose 1 to 2 drops ; the abstract (Abstractum Digitalis, U S.), J to 1 
grain ; the extract (JExtractum Digitalis, U. S.), J of a grain ; and the 
powdered digitalis leaves {Digitalis Folia, B. P.), dose 1 to 4 grains, 
generally given in pill. The tincture is the preparation most com- 
monly used, and is most satisfactory, although the infusion has been 
thought of greater value without any reason. 

The dose of digitaiin, which ought not to be used, is -^ of a grain. 



ELATERIUM. 

Elaterium, B. P., is a sediment obtained from the juice of the 
Ecbalium Elaterium, or squirting cucumber. It appears in small, 
easily broken, thin, grayish-green flakes, and has a bitter taste. 
Elaterium is not officinal in the U S. P., but its active principle, 
elaterin (Elaterinum, U. S. and B. P.), is. Notwithstanding this 
fact, the crude preparation is largely used. 

Physiological Action. — Elaterium is a very decided irritant to all 
mucous membranes, and even to the hands of those who handle it. 
Its chief effect in man is to cause profuse watery stools, but for some 
unknown reason it rarely acts upon animals in this manner. 

Therapeutics. — This drug is the best hydragogue purge which we 
have, causing very large watery passages, but not producing much 
pain when used in proper dose. Eor this reason it is useful in local 
serous effusion, as in pericarditis and pleurisy and in dropsy and ascites. 
It ought never to be used in cases of marked exhaustion, and may 



150 DRUGS. 

be advantageously followed soon after it acts by alcoholic stimulants. 
Iu urmmia, with dropsy, it is thought to aid in the elimination of 
the poison by the bowel. In cerebral congestions or effusions the 
drug will often be of service. 

In poisoning by elaterium the symptoms are those of violent 
gastro-enteritis and must be treated accordingly. 

Administration. — The dose of elaterium is J- of a grain, given in a 
freshly made pill. Elaterin is best given in the dose of from - r 1 g- to 
3*2 of a grain, as follows : 

R. — Elaterinse ........ gr. iv. 

Alcohol fgiv. 

M. — Dissolve by gentle heat. S. Half a drachm contains T ^ grain or one 
full dose. 

The officinal preparations of elaterin, the active principle of 
elaterium, are Trituratio Elaterini, U. S. (elaterin 1, sugar of milk 9), 
given in the dose of J- to f grain, and Pulvis Elaterini Compositus, 
B. P. (elaterin 1, sugar of milk 39), dose 1 to 5 grains. 



ERGOT. 

Ergot (£7. 8. and B. P) is derived from the spawn or mycelium 
of the fungus known as Claviceps Purpura, which grows in the 
flower and replaces the grain in common rye or Secale Cereale. 

Many so-called active principles have been isolated by chemists 
and named ecbolic acid, ergotic acid, sclerotinic acid, and ergotin. 
None of them represent the entire drug, the nearest in its approach 
bein^ ergotin, and under these circumstances ergotin is not an isolated 
principle, but a combination of principles. 

Physiological Action. — 

Nervous System. — Upon the nervous system ergot exercises 
little, if any, effect. In chronic poisoning, due to eating rye-bread 
contaminated by ergot, we sometimes see what is known as spasmodic 
ergotism due to disturbances of the circulation in the nervous system. 

Circulation. — Ergot when injected into the circulation causes a 
primary fall of arterial pressure, followed by a rise. The dominant 
action is represented in the rise. This rise is due to a stimulation of 
the vaso-motor centres, but the primary fall to a direct depressant 
effect upon the heart muscle, resulting from contact on the part of 
the drug en manse with the heart. 

If the dose be very large the fall of pressure is never recovered 
from, and progressive paralysis of the vaso-motor apparatus and 
heart occurs. 

Uterus and Unstriped Muscular Fibre. — Ergot acts as a 
stimulant to the uterine muscle, and causes contraction of unstriped 
muscular fibres everywhere. 



ERGOT. 151 

On the uterus it shows its influence, not by increasing the normal 
pains of labor, but by causing a tetanic, tonic, unyielding uterine 
spasm which drives all before it. 

This is only seen in parturient, and not in gravid, uteri. We do 
not know whether the action of ergot is upon the uterine nervous 
centres or upon the womb itself, but it is probably the latter. 

Therapeutics. — Ergot to be used in labor for the cure and pre- 
vention of post-parlum hemorrhages. For the prevention it should 
be given to the woman by the mouth just as the head is about to 
slip over or has slipped over the perineum, and not before. If ergot 
be given before this the constant contraction of the uterus prevents 
the circulation in the cord and placenta, and produces sloughs in the 
maternal soft parts because of the pressure of the foetal head. The 
fluid extract or wine should be used in the dose of 1 drachm or 4 
drachms, respectively. In post-partum haemorrhages the same dose 
or larger ones may be used, and the solution of the aqueous extract 
of ergot should be given hypodermically. The extract should be 
rubbed with the proper amount of water (parts 1 to 5), and filtered 
through a fine aseptic handkerchief to get rid of foreign bodies before 
it is injected. 

In hemorrhages from the lungs and kidneys, or other unapproach- 
able parts, ergot is very useful when given by the mouth. 

In epistaxis, menorrhagia, and metrorrhagia, and in some cases of 
night-sweats, it is of service. In hypostatic, pulmonary, and other 
congestions it is of service, particularly if used with digitalis. 

In dysenteries with true bloody stools and serous diarrhoea ergot 
sometimes does good. 

Ergot has been used very largely in uterine fibroids as an expulsive 
remedy and cure. It is only of value in those cases where the 
growths are just beneath the mucous membrane. By the contraction 
of the uterine fibres the blood-supply of the growth is decreased, the 
recurring haemorrhages cease, and the tumor is finally expelled, 
having really sloughed out of its bed. This method is inferior to 
the knife, and very painful and prolonged. Large growths cannot 
be so treated. Ergot is sometimes useful in bleeding hemorrhoids, 
and it has been given with success in diabetes insipidus. In some 
cases of chronic poisoning gangrenous ergotism comes on, due to local 
anaemias of the toes or other extremities, or it may be replaced by 
spasmodic ergotism. 

Administration.— Ergot is officinal in the U. S. P. as the fluid 
extract (Extractum Ergotce Flwidum), dose 1 drachm; the solid 
extract [Extractum Ergotce), dose 10 to 20 grains; and the wine 
(Vinum Ergotce), dose 2 to 4 drachms. Bonjean's ergotin is made 
by a special process, but it or the solid extract can be given hypo- 
dermically, as already described. The B. P. preparations are Extrac- 
tum Ergotce Liquidum, dose 10 to 30 minims; Infmum Ergotce, 1 to 
2 fluidounces; Tinctur a Ergotce, 10 minims to 1 fluidrachm. Ergotin 



152 DRUGS. 

(Ergotinum, B. P.) is given in the dose of 2 to 5 grains. Injeciio 
Ergotini Hypodermica, B. P. (ergotin 1, camphor water 2 parts) is 
given in the dose of 3 to 10 minims by subcutaneous injection. 



ERIGERON, OR FLEABANE. 

Oil of Erigeron (Oleum Erigerontis, U. S.) is a yellowish, volatile 
oil of a peculiar, not bad, taste, closely resembling turpentine. It is 
by far the best remedy which we have for passive uterine oozing, or 
a " show," as it is sometimes called. 

In epistaxis and other haemorrhages of a subacute type it is quite 
useful. In some instances it may supplant copaiba and cubebs in 
the later stages of gonorrhoea. It is best given in capsule or on 
sugar, in the dose of 10 to 30 drops after meals, or oftener if needed. 



ETHER. 

Sulphuric Ether is officinal as JEther, U. S. and B. P., and JSiher 
Eortior, U. S. Ordinary ether is not generally used as an anaesthetic, 
but for the abstraction of oils and other pharmaceutical purposes. It 
is made by the action of sulphuric acid on ethylic alcohol, and is 
sometimes called in consequence ethyl oxide. Ordinary ether contains 
about 74 per cent, of ethyl oxide and 16 per cent, of alcohol, with a 
little water. On the other hand, the stronger ether contains about 
94 per cent, of ethyl oxide and only 6 per cent, of alcohol, with 
water. Both preparations boil when held in a test-tube, if a piece 
of broken glass is added to the liquid. The stronger ether boils 
much more vigorously, however, than the weaker. 

Ether possesses a peculiar penetrating odor, a hot burning taste, and 
is a colorless, volatile, and very inflammable liquid. For this reason 
it should never be held near a fire or light, and, as its vapor is 
heavier than air, any light in the room should be above the patient, 
not below him. 'No light should be held nearer than five feet. 

Physiological Action. — The action of ether on the animal organ- 
ism is very rapid, powerful, and temporary. Except for the rapidity 
of its effects it is very much like that of alcohol. When applied 
to the skin it causes intense cold by its evaporation, and may be used 
to benumb or locally freeze a part. 

Upon mucous membranes it acts as an irritant and causes, when 
first inhaled, great irritation of the fauces and respiratory tract so 
that temporary arrest of respiration is not uncommon. The face 
becomes suffused and red and the conjunctiva injected, but a stage 
of physical quiet succeeds the primary stage of struggling which 



ETHER. 153 

arises from the choking sensations. During this period the breath- 
ing is generally full and deep and the pulse rapid but strong, while 
the ocular reflexes are at its beginning intact. Following this stage 
a second period of struggling comes on, in which the patient may 
become absolutely uncontrollable except by brute force. Yelling, 
shouting, screaming, cursing or laughing and crying may be promi- 
nent symptoms, and the individual is pugilistic, caressing or ill 
tempered, as the case may be. If the drug is now pushed a condi- 
tion of total anaesthesia is attained, and quietude takes the place of 
the struggles. This is the time for the operation to be carried on, 
for if it is attempted in the early stages the pain is not put aside, 
while the struggles of the second stage preclude any operative pro- 
cedure. It is not proper to push the muscular relaxation to complete 
flaccidity, as this endangers the respiration. 

Nervous System. — Ether act first on the brain, then on the 
sensory centres of the spinal cord, then on the motor centres, then on 
the sensory centres of the medulla oblongata, and, finally, upon the 
motor centres of the medulla with death from respiratory failure. 
Upon the nerve-trunks it exerts no effect unless it is directly applied 
to them. Ether does not act by influencing the blood, coagulating 
the protagon of the nervous system, or by any other destructive in- 
fluence. It simply puts aside, for the time being, the vital functions 
of the parts affected by it. 

Circulation. — Ether is one of the most diffusible and rapid 
cardiac stimulants which we possess, and is correspondingly fleeting 
in its effects. It increases the pulse-rate and force by stimulating 
the heart and by increasing the activity of the vaso-motor centres. 
In overdoses it acts as a cardiac depressant, but only when the 
amount is very large. 

Respiration. — When ether is first inhaled it often causes an 
arrest of respiration. According to Kratschmar, this is due to an 
irritation of the trifacial nerve which causes a reflex spasm of the 
glottis, and is not due to irritation of the peripheral vagi in the 
lungs. This is only partly true, for it has been proved 1 that section 
of the vagus nerve prevents its occurrence so that both the vagal 
and trigeminal irritation are responsible for the arrest. 

Upon the respiratory centre ether acts as a powerful stimulant in 
ordinary amounts, in overdose it paralyzes this part of the system. 

Temperature. — A prolonged etherization lowers the bodily heat 
very greatly. That of the dog may be lowered some 9° F. in an 
hour if the drug be pushed, and as great a fall has been known as 
4° F. in man (Hare). The fall is partly due to the depression of 
the nervous system and the chilling of the body and lungs by the 
evaporation of the drug. 

Elimination. — Ether escapes from the body by the lungs and 
kidneys. 

5 Hare: University Medical Magazine, 1889. 



154: DRUGS. 

Untoward Effects. — Ether, while safer than chloroform, is not: 
absolutely devoid of all danger. Sometimes when the drug is pushed 
too strongly .deep cyanosis with pulsation of the jugular veins shows 
deficient oxidation and cardiac distention. In other and very rare 
instances sudden cardiac failure has occurred, or total arrest of 
respiration ensued. In nearly all cases of sudden death from ether 
grave kidney or other lesions have been present, and has been shown 
at the autopsy. 

One of the earliest signs of the over-action of ether is the failure 
of diaphragmatic movement, followed by that of the lower part of 
the chest, then of the upper part and then of the cervical muscles. 

In patients under ether the movement of the diaphragm is an ex- 
ceedingly interesting study, for before the condition kuown as surgi- 
cal anaesthesia is developed, while there is still some rigidity, and the 
throat reflex is not completely abolished, the contractions of the 
diaphragm are frequently so violent that unless the laryngeal opening 
be absolutely free, the intercostal spaces are depressed and the ab- 
dominal contents thrust violently downward and outward. Just so 
soon, however, as the chin is pulled forward and a free access of air 
is allowed, the abdominal displacement is not so great, though it still 
remains present, and the chest movement is no longer reversed. As 
the ether is pushed, the respiration becomes purely thoracic, the dia- 
phragm no longer taking part in the respiratory cycle, or becoming 
so relaxed that it allows the chest on expansion to aspirate the 
abdominal viscera upward, as is shown by the retraction of the 
belly walls at a time when they should normally expand with the 
thorax in inspiration. This observation would seem to point to the 
fact that the primary stimulant action of ether upon the respiratory 
apparatus is particularly felt by those centres which govern the 
movements of the diaphragm, and that, as this is the case, these 
centres later on are the first to feel the paralyzing effect of still larger 
amounts of the drug. 

This gives us, therefore, yet another danger signal during the ad- 
ministration of the ether, and we hold that the integrity of the dia- 
phragmatic function, as represented by the movement of the belly 
walls, should be as carefully observed as are the thoracic excursions, 
the character of the pulse, or the condition of the pupil. The rule 
may therefore be laid down that when the diaphragm ceases to act, 
anaesthesia has been carried to its extreme legitimate limit, and that 
the use of an anaesthetic after this time must be carried on with the 
greatest care and watchfulness. 

The diaphragm is the first part of the respiratory mechanism to yield 
to respiratory paralysis. In death from any cause, the progress of 
failure of respiration will, in the vast majority of cases, be denoted 
by a failure on the part of the diaphragm primarily, with compensa- 
tory excursions of the chest ; and it is also to be noted that as the 
chest movements fail, the accessory muscles of the neck come into 



ETHER. 155 

play. These muscles in time cease to act, the hyoidean group lose 
their point oVappui, the chest remains motionless, the lower jaw is 
dropped, and the scene is closed by a few gasps in which the muscles 
of the neck may be the chief factors. 

The treatment of accidents consists in the withdrawal of the ether, 
the use of artificial respiration, the placing of the body, if the face 
is pale, head downwards and the hypodermic injection of strychnine, 
atropine, and digitalis, or the intravenous injection of ammonia, 
which is better still. Ether is often given hypodermically under 
such circumstances and seems to do good, but is a bad practice, as, if 
the heart or respiration is depressed already by ether, the use of still 
more of the drug simply makes matters worse. Where it does good 
the hypodermic injection of ether probably causes so much local pain 
and irritation as reflexlyto call up respiratory movements. 1 For the 
same reason alcohol ought not to be used if the other drugs named 
can be obtained, because alcohol is so nearly allied physiologically 
and chemically to ether. Frictions, hot applications, and artificial 
respiration should be practised (see article on Asphyxia). 

As ether is at hand it may be dashed on the chest and abdomen 
to cause reflex inspiration in lieu of cold water, which wets the clothes 
and does not evaporate. (Hare.) 

In some cases great nausea and vomiting follows the use of ether. 
This can generally be done away with by the proper use of food 
before the operation (see Therapeutics of Ether), and by the use of 
cracked ice and small doses of aconite. (See Vomiting.) Severe 
bronchitis may occur in invalids and children after the inhalation of 
ether. 

Therapeutics. — Ether is used chiefly as an anaesthetic by means of 
inhalation. The method consists in forming a cone out of a towel 
and a piece of paper and placing a small sponge in its end. Upon 
this sponge the ether is placed and the large open mouth of the cone 
is placed over the face. If this be done the sensation of suffocation 
is generally so great as to cause fright and struggling, which is inad- 
visable. The better way is to hold the cone at some distance from 
the face and gradually bring it nearer as the effects of the ether are 
felt. After partial anaesthesia is attained the cone should be placed 
closely over the face and the vapor be pushed in as concentrated a 
form as possible, whereas in using chloroform it should be w 7 ell 
mixed with a great amount of air. Care should be taken that the 
ether does not get into the eyes of the patient, either in vapor or 
liquid form, owing to the irritation which it will set up. To prevent 
this a thin piece of muslin wet with water will be found of service 
if placed over the eyes. 

When ether is to be given no food ought to be allowed the patient 

1 As consciousness is not necessary to the carrying out of a reflex action, this is per- 
fectly possible and probable. 



156 DRUGS. 

except a little milk or tea an hour or two before the operation in 
order to avoid vomiting during and after the procedure. The patient 
should have no tobacco or false teeth in the mouth, as they may slip 
into the larynx and cause death. 

Locally ether may be used in an atomizer spray as a local anaes- 
thetic owing to the cold produced. This is particularly useful in 
cases where thoracentesis or paracentesis abdominis is to be performed, 
and also in cases of superficial neuralgia, where the benumbing of 
the nerve often effects a permanent cure. 

Internally, by the stomach, ether is very useful in colic, although 
for flatulence of adults and children Hoffmann's Anodyne is generally 
used as a more agreeable remedy. In cases of collapse its hypoder- 
mic and gastric use make it of great service when cardiac action 
is very feeble, and it will give relief by inhalation in some of these 
cases more rapidly than the nitrite of amyl. 

In hiccough a few inhalations will often put aside the disorder, 
and local muscular spasms can be relieved in this way, thereby aid- 
ing in the reduction of hernise. 

In cases where cod-liver oil cannot be digested ether may be 
given in 20-drop doses in ice water or capsule, either with, or some 
minutes after the oil is taken, to aid its digestion and absorption. 
The time of its use should be that at which discomfort is apt to come 
on and not at any stated moment. The spirit of ether (8piritus 
Mlheris, U. 8. and B. P.) is a useful carminative in the dose of 30 
to 90 minims. 

Pure ether (JEther Purus, B. P.) is free from alcohol and water. 

Administration. — Ether should be used in ice-cold water or, better 
still, in capsules, in the dose of 30 drops to J ounce. If cold 
water is not used, so great are the fumes of the ether that deglutition 
is impossible. 

Contra-indications. — Ether should not be used by inhalation in 
bronchitis, acute nephritis, peritonitis or gastritis, or in aneurism and 
great vascular atheroma. 



ETHYL BROMIDE. 

Ethyl Bromide is a liquid employed as an anaesthetic, but possess- 
ing so powerful an influence over the heart as to make its employ- 
ment in prolonged operations exceedingly dangerous. It acts with 
even greater rapidity than chloroform, producing anaesthesia after 
the first, second, or third whiff, and rarely causes a preliminary 
stage of excitement. Those who have used it assert that the opera- 
tion may be begun in from five to twenty seconds after the first 
inhalation and that the inhalations may then be stopped at once, pro- 
vided the operation is a short one, such as opening a boil or abscess. 



EUONYMUS. 157 

It is to be remembered, however, that alcoholics are particularly sus- 
ceptible to its lethal influence and that the employment of the drug- 
throws a large amount of responsibility upon the surgeon. 



EUCALYPTUS. 

Eucalyptus, U. S., is the leaves of the Eucalyptus Globulus or 
Blue Gum Tree, a native of Australia, but grown at present all over 
the world. 

Their chief medical constituent is the oil of Eucalyptus {Oleum 
Eucalypti, U. S.), from which is derived Eucalyptol. 

Physiological Action. — Locally applied the oil is a decided irritant. 
Ten to twenty drops taken internally cause slight stimulation fol- 
lowed by a sense of calm, while larger doses produce disturbed diges- 
tion and loose, oily-odored stools. The pulse is increased in fre- 
quency and force and intense headache may come on. After very 
large doses there is a fall in pulse force, bodily temperature, and 
strength of limb and the respirations are decreased. A peculiar loss 
of sensation in the lower limbs may occur. If death oocurs it is due 
to respiratory failure. The drug is eliminated by the skin, kidneys, 
bowels and lungs. The urine may have the odor of violets, as it 
sometimes does from the use of oil of turpentine. 

The oil of eucalyptus has considerable antiseptic power. 

Therapeutics. — Eucalyptus is used in malarial fever where quinine 
cannot be had or be borne by the patient owing to idiosyncrasy. In 
bronchitis in an emulsion or in capsule it is of great value in the later 
stages (see Bronchitis), and it may be used in the subacute forms of 
gonorrhoea in the same manner, since in its elimination by the lungs 
it acts locally upou the inflamed mucous membrane. 

Oil of eucalyptus is very useful in some forms of rheumatic head- 
ache or in headache dependent upon a history of malarial fever. 

Administration. — The extract (Extr actum Eucalypti Eluidum, 
U. S) is given in the dose of 10 drops to 2 drachms. The oil 
(Oleum Eucalypti, U. S. and B. P.) in the dose of 5 drops. 

Unguentum Eucalypti is officinal in the B. P., but is seldom used. 



EUONYMUS. 

Euonymus, U. $., or Wahoo is the bark of Euonymus Atropurpureus, 
a native of the United States. It contains an active principle Eu- 
onymiu. As a laxative its action is very slow and moderate but it is 
thought to act particularly on the liver and may be used when mild 
hepatic torpor is present. 



158 DRUGS. 

Administration, — The close of the solid extract (Extractum Eu- 
onymi, U. 8.) is 3 to 10 grains. 



EUPATORIUM. 

Eupatorium, U. 8., Thoroughwort or boneset is the leaves of the 
Eupatorium per foliatum, an American plant which is used as a simple 
bitter tonic and diaphoretic very largely in household medicine. The 
drug is generally given in hot infusion in arrested menstruation due 
to cold, or in the chill of a remittent or intermittent fever, and also in 
anorexia and debility. Its taste is very disagreeable, and in the dose 
of a pint of the cold infusion it has been used as an emetic. The 
fluid extract {Extractum Eupatorii Eluidum, U. 8.) is given in the 
dose of 30 drops to 1 drachm. 



FILIX MAS. 

Aspidium, U. 8., Filix Mas, B. P., or Male Fern, is employed in 
medicine as a tseniacide or remedy against the tape-worm, and is a 
very efficient and valuable drug under such circumstances, being, 
perhaps, the most reliable of all the vermifuges except pelletierin. 
When employed against the tape- worm the directions and precau- 
tions given in the article on Worms must be strictly followed. 

Administration. — Male fern is rarely, if ever, used at present in its 
crude form, being employed most commonly in this country in the 
form of the oleoresin {Oleoresina Aspidii), dose J to 1 fluidrachm in 
capsules, or as follows : 

R. — Oleoresin. aspidii, 

Tinct. vanillse . . . . . aa TTL X ^ v - 

Pulv. aoacise . . . . . . sjss. 

Aq. destillat. fjj. 

M. — S. Take entire amount after fasting, and follow in two hours by a full 
dose of castor-oil or sulphate of magnesium. 

The oleoresin (Oleoresina Aspidii, U. 8.) is given in the dose of 
J to 1 drachm ; the dose of the liquid extract Extractum. Filicis 
Liquidum) of the B. P. is 15 minims to 1 fluidrachm. 



FLAXSEED. 

Flaxseed or Linseed, (Linum, U. 8.), is the seed of linum usita- 
tissimum or flax from which linen is made ; it is officinal in the 
B. P. as Lini 8emina. It contains an oil and a mucilage, the first of 
which is largely used in the arts, and the second sometimes employed 



GALLIC ACID. 159 

in medicine. The oil (Oleum Lini, U. S. and B. P.) is also used by 
physicians and pharmacists for various purposes. 

Therapeutics. — Flaxseed acts as a demulcent to inflamed mucous 
membranes, and is used largely in acute cystitis, bronchitis, gastritis, 
nephritis and similar states in the form of fiaxseed-tea. This is pre- 
pared by mixing together 3 drachms of flaxseed, not ground, SO 
grains of extract of licorice, 10 ounces of boiling water, and allow- 
ing the mixture to stand one to four hours in a warm place. If 
the mixture be boiled the oil is set free and makes the dose disagree- 
able. This infusion may now be made more tasteful and useful by the 
addition of a little lemon-juice and sugar and by the placing of from 
1 to 2 drachms of gum-arabic in the pitcher containing it. If the 
cough is excessive, a little paregoric may be added. Linseed oil is 
used sometimes as a laxative in the dose of 2 ounces, and is said to 
be of service when so given in hemorrhoids. 

Flaxseed meal (Lini Farina, B. P.) is used universally as a useful 
poultice. 

Under the name of carron oil, an emulsion of lime-water and lin- 
seed oil, equal parts, is the standard application to limited or extensive 
burns. 

An infusion of linseed (Lnfusum Lini) and a poultice (Cataplasma 
Lini) are officinal in the B. P. 



GALLIC ACID. 

Acidum Gallicum ( U. S. and B. P.) is prepared from powdered 
nut-galls by a somewhat complicated and prolonged process. It 
occurs in nearly colorless, long, needle-like crystals, which are solu- 
ble in 100 parts of cold water, 4J parts of alcohol, and 3 parts of 
boiling water. 

Physiological Action. — Gallia acid is an astringent but not a coag- 
ulator of blood. Locally applied in bleeding it is useless, but given 
internally in haemorrhages, which cannot be acted upon by tannic 
acid, it is useful as a haemostatic. It is eliminated from the body, as 
gallic acid, by the kidneys. 

Therapeutics. — Gallic acid may be used with much success in 
hameduria, haemoptysis, colliquative sweats, and in bronchorrhoea with 
profuse expectoration. 

Combined with opium it is one of the best remedies in diabetes 
insipidus, and is even useful in diabetes mellitus. 

In albuminuria dependent upon a relaxed atonic state of the kid- 
neys and in night-sweats and acute or chronic diarrhoea, gallic acid 
may be used with advantage. In the form of the ointment it is useful 
in psoriasis, and in ulcers and sores which are actively discharging. 

Administration. — Gallic acid is given in the dose of 2 to 40 grains 



160 DRUGS. 

in pill or solution. It ought never to be used with any salt of iron, 
as it is incompatible. The officinal preparations are Unguentum 
Acidi Galilei, U. S., and Grlycerinum Acidi Galilei, B. P., given in 
the dose of 10 to 60 minims. 

Nut-galls (Galla, U S. and B. P.) are the small excrescences 
found upon the oak (Quercus Infectoria) formed by the ova of the fly 
Cynips Tinctoria. Their sole value depends upon the tannic acid con- 
tained in them, and they are officinal in the form of the tincture 
(Tlnctura Gallce, U 8. and B. P.), dose J to 2 fluid rachms ; aud the 
ointment. ( Unguentum Gallce, U S. and B. P.). Unguentum Gallce 
cum Opio is officinal in the B. P., and is used as an astringent 
ointment, 



GAULTHERIA. 

Wintergreen, or Gaultheria Procumbens, is an American evergreen 
containing a volatile oil. The oil possesses a peculiar, exceedingly 
penetrating smell and a warm aromatic taste. It is about 90 per cent, 
salicylate of methyl. 

Physiological Action. — Owing to the large amounts of salicylate 
of methyl contained in the oil its physiological action is almost iden- 
tical with that of salicylic acid. (Wood and Hare.) 

Therapeutics. — Aside from its use as a flavoring substance, oil of 
gaultheria is largely used in all forms of rheumatism, and in place of 
the ordinary salicylates. It does not so commonly disturb the diges- 
tion of patients as do the salts of salicylic acid or the acid itself. The 
oil [Oleum Gaulfherice, U. S.) is best given in capsules or emulsion, 
or dropped on a teaspoonful of sugar, three times a day after meals. 
The dose may be as high as 100 drops a day ; if 60 drops three 
times a day, do no good, pushing it further is useless. 

The spirit of gaultheria (Spiritus Gaultherlce, U. S.) is given in 
the dose of 10 to 20 minims. 



GELSEMIUM. 

Gelsemium, U. S. and B. P., or yellow jasmine, as used in medicine, 
is the rhizome of the Gelsemium Sempervirens, a climbing plant of 
the southern United States. It contains an alkaloid Gelsemine aud 
Gelseminic acid. 

Physiological Action. 

Nervous System. — Gelsemium paralyzes the spinal cord, par- 
ticularly on its sensory side (?), although the motor side is certainly 
ultimately depressed. It does not influence the nerves or muscles 



GELSEMIUM. 161 

except those of the head, on which it acts as a paralyzant to the 
motor fibres. 

Circulation. — Gelsemium is a depressant to the circulation, act- 
ing particularly ou the heart. 

Respiration. — Gelsemium kills by paralyziug the respiratory 
centres (Sanderson, Ringer, and Murrell). 

Temperature. — In overdose the drug lowers bodily heat very 
markedly. 

Eye. — Gelsemium is a mydriatic of considerable power, causing, 
when dropped into the eye, wide dilatation of the pupil, a result due 
to paralysis of the oculo-motor nerve. It is apt to cause temporary 
internal squint owing to its paralyzant action on the sixth pair of 
cranial nerves. 

Therapeutics. — Gelsemium is used in headache and migraine de- 
pending on nervous troubles or eye-strain. It is particularly useful 
in combination with cannabis indica. (See Cannabis Indica and 
Migraine.) 

In malarial fever it is said to be of great service, but this is doubt- 
ful. In pneumonia and pleurisy it has been highly spoken of by 
Bartholow. 

Gelsemium has also been found of value in asthma, whooping- 
cough, laryngismus stridulus, and nervous cough. In localized mus- 
cidar spasm, as is seen in torticollis or ivry-neck and in spasmodic 
dysmenorrhoea, it is of considerable service. It ought not to be used 
if the system is already depressed, but be employed in strong sthenic 
cases. 

When used as a mydriatic Tweedy recommends it as equal to 
atropine in effect, but much more transient in its influence. He uses 
a solution of 8 grains of gelsemine to the ounce of water, instilled, 
drop by drop, into the eye every fifteen minutes for one hour, and 
then every half hour for two hours. 

Poisoning. — The most prominent symptoms of gelsemium poison- 
ing are ptosis and dropping of the jaw. This is preceded by a sen- 
sation of languor, a desire to lie down, relaxation and muscular 
weakness The pulse becomes rapid and feeble, the skin wet and 
cold, the face pinched and anxious, the voice loses itself in aphonia, 
and death ensues from centric respiratory failure and an almost 
simultaneous cardiac arrest. Sensation in man is impaired very late 
in the poisoning. 

Treatment of the poisoning consists in the use of cardiac stimu- 
lants, such as ammonia, digitalis, and atropine, the application of 
external heat, and the employment of atropine and strychnine for the 
respiratory centre. Emetics and the stomach-pump are, of course, to 
be employed. 

Administration. — The fluid extract (Extractum Gelsemii lluidum, 
U. 8.) is given in the dose of 5 to 10 minims, and the tincture 
(Tinctura Gelsemii, U. S. and B. P.) 10 ■ to 20 drops. Gelsemine 

11 



162 DRUGS. 

may be used in the dose of -^ of a grain. Extr actum Gelsemii 
Alcoholicum, B. P., is given in the dose of J to 1 grain. 



GENTIAN. 

Gentiana, U. S., is the root of the Gentiana Lutea or yellow gen- 
tian, a European plant. It contains gentianiue and gentisic acid 
and has a bitter taste. This drug is officinal in the B. P. as Gentiance 
Radix. 

Therapeutics. — Gentian is one of the most efficacious bitter tonics 
that we possess, as well as one of the most elegant. In the anorexia 
following acute diseases and in gout and malarial poisoning with dys- 
pepsia, it is of service. Combined with bicarbonate of sodium it is 
of great service in the gastric and intestinal catarrh of children. 

Administration — The compound tincture (Tinctura Gentiance 
Composita, U. S. and B. P.) is given ' in the dose of a drachm to a 
wineglassful, the fluid extract (Extractum Gentiance Fluidum, U. S.) 
in the dose of 30 drops to a drachm, and the solid extract (Extractum 
Gentiance, U. S. and B. P.) in the dose of 1 to 8 grains. Infusum Gen- 
tiance Compositum, B. P., is given in the dose of 1 to 2 fluidounces, 
and the compound tincture (Tinctura Gentiance Compositus) in the 
dose of J to 1 fluidrachm. The compound tincture and infusion are 
composed of gentian, bitter orange peel, and cardamoms. 



GERANIUM. 

Geranium, U. S., is the rhizome of Geranium Macidatum. It con- 
tains tannic aDd gallic acid and is useful in diarrhoea as an astrin- 
gent. It is not the common red geranium seen in flower gardens. 

In infantile diarrhoea geranium root boiled in milk in the propor- 
tion of one or two roots to the pint will be found of great service, 
and is lacking in taste. The dose of the drug itself is 20 to 60 
grains, and that of the fluid extract (Extractum Geranii Fluidum, 
U. 8.) | to 1 fluidrachm. 

GINGER. 

Zingiber, U. S. and B. P., in the rhizome of Zingiber Officinale, a 
plant of Hindoostan, Jamaica, and other tropical counties. Black 
ginger is the dried rhizome with its bark, while white ginger has 
this covering removed. It contains a hot volatile oil and an aro- 
matic resin and is very largely used in domestic medicine as a car- 
minative and stomachic. In menstrual cramps it is often given and 



GLYCERIN. 163 

is particularly useful in those due to suppression from cold. With 
purgative medicines it is employed for its flavor and the prevention 
of griping. Of itself it is decidedly constipating, and when used 
in diarrhoea mixtures is of value other than as a flavoring addition 
to the prescription. 

Administration. — The fluid extract (JExtradiwm Zingiberis Fluidum, 
U. 8.) is given in the dose of 10 to 30 drops, well diluted. The 
tincture (Tinciura Zingiberis, U. 8. and B. P), 20 drops to 2 drachms ; 
the syrup (Syrupus Zingiberis, U. 8. and B. P.), dose, 30 drops to 2 
drachms; the oleo-resin (Oleoresina Zingiberis, U. 8.), dose, J to 1 
drop, well diluted, or in pill, and the troches (Trochisci Zingiberis, 
U. 8.) used as stimulants to salivary secretion. In the B. P. a 
stronger tincture, Tinciura, Zingiberis Fortior, is officinal, dose 5 to 
20 minims. 



GLAUBER'S SALTS, OR SULPHATE OF SODIUM. 

8odii 8uJphas, U. 8. and B. P., is one of the most irritant of the 
saline purges, rarely used in human medicine, but largely employed 
by veterinarians. The purgative dose for man is half an ounce to 
an ounce. If any inflammation is present it is contra-indicated. It 
produces large watery stools, with a good deal of griping, Sulphate 
of sodium is a prominent constituent of Carlsbad water, Hunyadi 
Janos, Hunyadi Arpad, and similar waters. 



GLYCERIN. 

Grh/cerinum, U. 8. and B. P., is a liquid obtained by the decom- 
position and distillation of fats. It possesses great power of absorb- 
ing water and of dissolving many substances. Even if pure it 
irritates the skin of susceptible persons by its absorption of water, 
causing a slight rash. 

Physiological Action. — Injected into the circulation it causes, in 
large amounts, convulsions, which are due to its hydroscopic powers. 

According to the clinical researches of Pavy, glycerin increases 
the polyuria of diabetes almost one-half, and for this reason he thinks 
it is not to be employed in this class of cases as a substitute for 
sugar. Again, the experiments of Luchsinger and Weiss have 
seemed to show that the administration of this substance increases 
the amount of glycogen in the liver to very considerable extent ; 
while, on the other hand, the researches of Eckhard and Luchsinger 
have also proved that glycerin very frequently tends to prevent 
glycosuria when brought about by puncture of the so-called diabetic 
centre in the floor of the fourth ventricle, if the drug be given hypo- 



164 DRUGS. 

dermically. Lnchsinger, therefore, believed that while glycerin 
might increase the amount of glycogen, it also prevented its trans- 
formation into sugar by inhibiting the amylolytic action of the 
hepatic ferment. Eckhard believes that the hypodermic iujection of 
glycerin produces such radical chaDges in the blood and general 
system that no conclusion can be made of the proper influence 
exerted by it. In an exceedingly useful and interesting paper, both 
from a physiological and clinical standpoint, Ransom, of London, has 
recently gone over this work in a satisfactory manner, and has tried, 
with considerable success, to unravel the somewhat complex function 
of the part, as well as the equally complex opposing statements of 
investigators. He points out that one element of fallacy in all these 
experiments is the fact that glycerin, when given hypodermically, 
must reach the liver so slowly and in such a diffused state as to be 
almost powerless, and, in consequence, Ransom introduced the glycerin 
into the alimentary canal. All the experiments seem to have been 
made in a most painstaking and careful manner, and, as we have 
not space for their detail, we must pass them by in order to reach 
the results attained. They are as follows : 1. Certain forms of 
glycosuria may be checked by glycerin. 2. Glycerin acts more effi- 
ciently when introduced into the alimentary canal than when injected 
subcutaneously. 3. Glycerin checks glycosuria by inhibiting the 
formation of sugar in the liver. 4. By this means glycerin increases 
the quantity of glycogen found in the liver. While these conclusions 
are not final in proving the value of glycerin under such circum- 
stances, it would seem probable that they are of great value in 
pointing toward a solution of one of the most complex subjects with 
which physicians are called upon to deal, and it is to be hoped that 
Ransom will publish other researches at a future time, which will 
further elucidate this difficult subject. The quantity of glyceVin 
which the writer would recommend to be given clinically is 1 
drachm diluted with water at least one-half. 

Therapeutics. — Glycerin may be employed as a sweetening agent 
in the food of diabetics and in cases where sugar cannot be used. 
It has also been given as a laxative in 1 or 2 drachm doses by the 
mouth, and in enema of 1 to 4 drachms with or without equal parts 
of w T ater. In some cases it may be used in suppository. This latter 
way is very successful in chronic constipation. 

As an antiseptic it is used for preserving specimens and alkaloids 
in solutions for hypodermic use. 

In acute coryza, applied by a spray or brush to the nostrils, it is 
often of service. If used on the skin it should be diluted one-half 
with water. In cases of impacted cerumen in the external auditory 
canal it is often of service to soften the mass. 

The uses of glycerin, other than those mentioned, are many. In 
the proportion of 1 part of glycerin and 1 of water it makes a very 
useful mouth-wash on a rag in the sore and dry mouth of typhoid fever 



GRINDELIA ROBUSTA. 165 

and for the removal of sordes. The same wash, with lemon juice 
added to it, relieves the dry, glazed tongue of advanced phthisis. 

Owing to the fact that glycerin is hydroscopic, it may be used on 
a pledget of cotton in congestion of the uterine cervix as a depletant, 
the tampon being renewed daily. 

For the prevention of bed-sores Ringer recommends the daily 
washing and rubbing of the part likely to be affected, followed by 
the application of glycerin, and a draw-sheet placed smoothly against 
the patient to protect the bedding. 

Glycerin and whiskey is a favorite household remedy for colds and 
coughs, but is not very useful. Plasma, or glycerite of starch 
(Glyceritum Amyli, U. S. and B. P.), is used as a protective. 
Glycerite of yolk of egg [Glyceritum Vitelli, U.S.) is used in making 
emulsions. 

The B. P. preparations of glycerin are as follows : Glycerinum 
Acidi Carbolici ; Glycerinum Acidi Gallici ; Glycerinum Acidi 
Tannici ; Glycerinum Aluminis ; Glycerinum Boracis ; Glycerinum 
Plumb i Subaeetatis, and Glycerinum Tragacanth.ee. 



GRINDELIA ROBUSTA. 

Grindelia, U. S., is an American plant (Grindelia Pobusta) con- 
taining a resin, a volatile oil, and an alkaloid. 

Physiological Action. — Upon the lower animals and man this 
drug is not very powerful in its action, but may cause, in large 
doses, paralysis of the peripheral sensory nerves, the sensory centres 
in the cord, and finally the motor centres and nerve-trunks. It 
slows the heart by stimulating the vagi, and raises blood-pressure by 
stimulating the vaso-motor centre. 

Therapeutics. — This is an exceedingly useful remedy in some 
cases of asthma, and in bronchitis in its later stages. It may be 
given in the dose of 20 to 60 drops of the fluid extract (Extractum 
Grindelia? Fluidum), or by means of inhaling the fumes of burning 
grindelia leaves which are previously soaked in a solution of nitre, 
dried, and burned on a plate, or rolled into a cigarette and smoked. 
In chronic cystitis it stimulates the bladder, and is of great service. 
By diluting it 1 to 10 with water it forms one of the best lotions we 
have for the poisoning by poison ivy or Rhus Toxicodendron. 

Administration. — The only preparation which is officinal is the 
fluid extract (Extraction Grindelice Fluidum, U. S.), dose 20 to 60 
drops. 



166 DRUGS. 

GUAIAC. 

Lignum Vitse is G-uaiacicm Officinale, a West Indian tree. It is 
used in medicine in two forms — namely, as Guaiac wood (Guaiaei 
Lignum, U. S. and B. P.), which is in raspings and enters into the 
compound syrup of sarsaparilla, and Guaiac resin {Guaiaei Resina, 
U. S. and B. P.) or Guaiac, which is soluble in alcohol, ether, and 
chloroform, but insoluble in water. 

Therapeutics. — -Guaiac has been used largely in syphilis but is now 
almost discarded. Given in acute tonsillitis in the dose of 30 grains 
in an emulsion made by the use of white of egg it will often abort 
the disease. In rheumatism it has been largely used. The amnio- 
niated tincture of guaiac is sometimes employed in sore throat, par- 
ticularly if it be rheumatic in type, but is a disagreeable preparation 
to take into the mouth. 

Administration. — The tincture (Tinctura Guaiaei, U. S.) is given 
in the dose of 5 to 60 drops, and the ammoniated tincture (Tinctura 
Guaiaei Ammoniata, IT. S. and B. P.) is used in the same dose, pre- 
ferably in milk. Mistura Guaiaei, B. P., is given in the dose of 1 



GURJUN OIL. 

Gurjun Oil, or, as it is sometimes called, Gurjun Balsam, or Wood 
Oil, is the exudation obtained, by incision and the application of 
heat, from the bark of an East Indian tree. It is a transparent 
liquid possessing the consistency of olive oil, of a greenish-gray color 
when held up to the light. It has an aromatic odor resembling to 
some extent that of copaiba. It is not, however, so disagreeable. 

Therapeutics. — Gurjun oil has been found of value in cases of 
chronic bronchitis where a stimulating expectorant of considerable 
power was desired, and this is particularly the case if the mucus in 
the bronchial tubes is very tenacious. The oil has also been found 
of value in gonorrhoea and gleet in place of copaiba and cubebs. 

Administration. — Gurjun oil is best given in the dose of from 1 to 2 
drachms three times a day, combined with spirit of nitrous ether, 
mucilage of acacia and cinnamon water, or mixed with extract of 
malt in the proportion of 2 drachms of the oil to an ounce of the 
extract. Persons having irritable stomachs may not be able to take 
this drug. 



HAMAMELIS. 

Hamamelis, U. S., Witch-hazel, or Hamamelis Virginica, is a 
plant of the United States, devoid of any true active principle, but 
possessing extraordinary power. 

According to the studies of Wood and Marshall it has absolutely 



HOFFMANN'S ANODYNE. 167 

no physiological action, yet practically we know it to be a most useful 
remedy. 

Therapeutics. — Hamamelis is wonderfully successful in the treat- 
ment of uterine oozing from small bloodvessels, seems to do good 
even in hcematemesis and haemoptysis, and will sometimes arrest 
hcematuria when all other remedies fail. Applied by means of cloths 
to leg ulcers it acts very thoroughly, and relieves the angry-looking 
skin at once. In bleeding from the bladder it may be injected into 
that viscus daily in the form of the distilled fluid extract. Taken 
internally and applied locally it is of value in bleeding and the so- 
called blind piles. 

Injected into the part or taken internally hamamelis is of value in 
varicose veins. 

Administration. — The one officinal preparation is the fluid extract 
(Extractum Hamamelidis Fhiidum, U. /SI), dose 5 to 20 drops The 
dose of the distilled extract, which is not officinal, and is a perfectly 
clear liquid, is from 30 drops to 1 drachm, and is much the best 
preparation for internal and external use. Unfortunately the prepa- 
rations of the drug vary very much both in odor and efficacy. 

HiEMATOXYLON. 

Hcematoxylon, U. S., Hcematoxyli Lignum, B. P., or Log-wood is 
the heart-wood of Hcematoxylon Campechianum, a tree of the American 
tropics. It contains an alkaloid hematoxylin. 

Therapeutics. — Haematoxylon is a mild astringent, very useful in 
serous diarrhoeas and in the diarrhoeas of young children, as they do 
not dislike it, owing to its agreeable taste. (See article on Diar- 
rhoea.) As it colors the stools and urine red, the nurse should be 
warned, lest she be alarmed at the sight of what looks like blood on 
the diaper when the drug is given to infants. In leucorrhoea its 
internal use is of service. The extract {Extractum Hcematoxyli, 
U. S. and B. P.) is given in the dose of 8 to 30 grains, and De- 
coctum Hcematoxyli, B. P., 1 to 2 fluidounces. 

HOFFMANN'S ANODYNE. 

Spirilus ^Wieris Compositus, U. S. and B. P., consists of alcohol, 
ether, and the heavy oil of wine. The writer has experimentally 
studied very thorou^hlv the action of the last-named ingredient, and 
finds : 

First. That the belief in heavy oil of wine being the quieting 
agent in Hoffmann's anodyne is fallacious. 

Second. That the calmative effects of this mixture depend largely 
on the ether, rather than on the oil. 

Third. It would seem probable that in Hoffmann's anodyne we 
possess an agent in which there are linked together three drugs of 



168 DRUGS. 

undoubted power, each one of which successively substitutes the 
other, stimulating the system in the order here named, viz , ether, 
alcohol, and the heavy oil of wine. 

On animal temperature, as ascertained by the thermometer in the 
rectum, no effect is produced, even when the arterial pressure is very 
low. That large doses of the heavy oil of wine are in no way pos- 
sessed of toxic effects is proved by the fact that 30 c.c. of the drug 
given by the mouth to a small dog, weighing twelve pounds, failed to 
produce any apparent symptoms, except, perhaps, to stimulate him 
slightly. While the odor of the oil is penetrating it is by no means 
disagreeable, and it possesses but little taste other than that of the 
presence of an oily substance. 

Therapeutics. — Hoffmann's anodyne is the best carminative that we 
possess for general use, and is one of the best remedies for singultus or 
hiccough. These influences are accomplished probably in two ways: 
The alcohol and ether act as irritants or stimulants to the gut and 
free peristalsis results, while the heavy oil of wine perhaps acts as 
a nervous sedative. In angina pectoris this combination is often 
the best remedy we have, and in the cardiac palpitation of tobacco- 
heart or that arising from indigestion it is very useful. 

In the nausea and depression seen after excessive smoking, Hoff- 
manu's anodyne should always be given iu capsules or in cold water, 
preferably ice cold in order to prevent too rapid volatization of the 
ether and consequent difficulty in swallowing. 

The dose is 1 to 2 drachms to an adult. 



HOMATROPINE HYDROBROMATE. 

Hydrobromate of homatropine, properly applied by frequent instil- 
lations, is a reliable mydriatic for the correction of anomalies of 
refraction in healthy eyes. Experience is not at hand to determine 
its value for this purpose in eyes affected with retino-choroidal dis- 
turbance. Atropine and hyoscyamine are preferred under such circum- 
stances, for the obvious reason that their prolonged action is desirable 
as a method of treatment. The danger of systemic disturbance from 
homatropine is far removed, even when repeated instillations have 
been made and its temporary action upon the pulse causes no incon- 
venience to the patient. Slight hyperemia of the conjunctiva almost 
invariably follows its use, and true conjunctivitis, if it occurs at 
all, must be excessively rare. According to the studies of Dr. de 
Schweinitz and the writer, the drug has a physiological action closely 
allied to that of atropine, from which it is derived. Homatropine 
mydriasis generally lasts from 36 to 48 hours, that of hyoscyamine 
8 to 9 days, and that of atropine 10 to 1 2 days. For the production 
of ordinary mydriasis the drug should be used in solution of the 
strength of 4 grains to the ounce of distilled water which is to be 
dropped into the eye every 5 or 10 minutes. 



hops. 169 



HONEY. 



Honey, or Mel, U. 8. and B. P., is the saccharine fluid deposited 
in combs by the honey bee or Apis Mellifiea. It is used to cover 
the taste of disagreeable medicines. When it is abstracted from a 
peculiar variety of flowers it frequently has the odor of the flower, 
and may even produce the physiological effects of the plant when 
taken internally. This occurs commonly in those parts of the 
country where the bees have had access to mountain laurel and 
similar plants. 

Therapeutics. — Honey is used as an emollient in gargles and to 
relieve cough and dryness of the mouth and fauces. When used as a 
gargle it very distinctly increases the secretion of the mucous mem- 
brane, and so relieves the congestion. 

Under the name of Oxymel the B. P. recognizes a mixture of 8 
parts of honey, 1 of acetic acid, and 1 of water. This is generally 
used as a vehicle for more active remedies in gargles, or even for 
expectorant mixtures. Melted and strained honey is known as Mel 
Despumatum, U. S., and Mel Depuratum, B. P. There are also a 
honey of roses (Mel Posce, U. 8.) and a confection (Confectio Posce, 
U. 8.) used as vehicles for other drugs. 



HOPS. 

Humulus, U. 8., are the strobiles of ordinary hops or Hamulus 
Lupulus. They contain a liquid volatile alkaloid lupulin and a 
bitter principle lupulinic acid, flops are known under the name 
of Lupulus in the B. P. 

Therapeutics. — Hops are used as antispasmodics and nervous seda- 
tives in cases of hysteria and nervousness. In priapism, vesical irri- 
tability, and renal irritation they are of service. Even in delirium 
tremens they seem to be of value. For locally application a hop 
poultice may be made by placing the powdered strobiles in the mass, 
and employed in this way they are a favorite home remedy for local, 
painful inflammations. Hops have been used in the form of a hop 
pillow in nervous insomnia, but this influence is largely imaginary, 
or depends on the fumes of the alcohol with which the pillow is 
moistened. 

Administration. — The tincture (Timtura Humuli, U. S.) is given in 
the dose of \ to 3 ounces, the alkaloid (Lupulinum,U. 8. and B.P.), 
dose 2 to 5 grains or more; the oleoresin of lupulin (Oleoresina 
Lupulini, U. 8.), dose 10 to 40 drops in capsules, and the fluid ex- 
tract (Extractum Lupulini Fluidum, U. 8.), in the dose of 30 to 120 
drops. The preparations of the B. P. are the extract (Extractum 



170 DRUGS. 

Lupuli), dose 5 to 10 grains; the infusion (Infusum Lupuli), dose 
1 to 2 fluidounces, and the tincture (Tinctura Lupuli), dose J to 2 
fluid rachms. 



HOPE'S CAMPHOR MIXTURE. 

This is a mixture originally made with nitrous acid, but largely 
used at present with nitric acid, owing to the fact that nitrous acid 
is changed into nitric acid when water is added to it. The nitrous 
acid is, however, more efficacious than nitric acid in the serous or 
choleraic diarrhoeas which it is used to combat. The formula is as 
follows : 

Be. — Acid. Nitrosi fjj. 

Aquse Camphoras ....... Hjjviij. 

et add. 

Tinct. opii . gtt. xl. 

S. — One-fourth of this every three or four hours. 



HYDRASTIS. 

Hydrastis, U. S., is the rhizome of the Hydrastis Canadensis con- 
taining two alkaloids, known as hydrastine and berberine, and, 
perhaps, xanthopuccin . 

Physiological Action. — In poisonous doses hydrastis may cause 
convulsions followed by paralysis, according to the quantity of ber- 
berine or hydrastine present. The latter is more convulsive in its 
effects than the former. Upon the circulation hydrastine, when 
injected into the jugular vein, causes a primary fall of arterial pres- 
sure succeeded by a decided rise, and the studies of Dr. Cerna, in 
the laboratory of the University of Pennsylvania, have proved that 
it is an active poison producing convulsions followed by paralysis. 

Therapeutics. — Hydrastis is of service in chronic gastro-intestinal 
catarrh, particularly that following the abuse of alcohol, and may be 
used as a stomachic and tonic after malarial fever and similar de- 
pressing diseases. Wherever membranes exist in a condition of 
lowered tone this drug will be indicated. Thus in catarrhal jaun- 
dice of a subacute type, in uterine catarrh, in leucorrhoea dependent 
upon a relaxed state of the vagina, and in chronic nasal inflamma- 
tions and irritations it will be found useful. 

Tincture of hydrastis is said to possess a distinct anti-malarial 
influence. 

One of the best remedial measures that we have in the later stages 
of gonorrhoea, when the acute period has passed, is the local and 
internal use of hydrastis. If it is used as an injection 5 grains of the 



HYDROCYANIC ACID. 171 

commercial hydrastine to each ounce of water should be employed 
twice a day. If this is not used the following infusion will be found 
of service : Take 1 drachm of the powdered root and add it to 8 
ounces of boiling water. Half to one drachm of the fluid extract 
may also be added to a pint of water and used as a wash in vaginal 
gonorrhoea and leucorrhcea. In chronie dyspepsia it seems to act as an 
antiseptic and as a curative agent to the mucous membranes of the 
stomach. 

Administration. — The fluid extract (Extractum Hydrastis Fluidum, 
U. S.) may be given in the dose of 5 to 30 drops, while the dose of the 
tincture (Tinctura Hydrastis, U.S.) is from 30 drops to 2 drachms. 

Much doubt exists as to the dose of hydrastine. This arises from 
the fact that two forms of it are sold. That most commonly seen is 
impure, and contains berberine and other substances. Its dose is 3 
to 10 grains. The pure hydrastine, made by Merck, is given in the 
dose of J to J grain. 



HYDROCHLORIC ACID. 

Acidum Hydrochloricum (U. S. and B. P.) is a clear, colorless 
liquid, possessing an acid odor and taste, devoid of astringency, but 
in concentrated form decidedly caustic. In the strength of two- 
tenths of 1 per cent, it is present normally in the gastric juice and 
aids the pepsin in the conversion of proteids into peptones, and in 
the formation of pepsin from pepsinogen. 

Therapeutics. — In dyspepsia due to faulty gastric secretion, as in 
typhoid fever and in gastric indigestion, accompanied with fermenta- 
tion, this acid is of service. In combination with compound tincture 
of cardamoms it is of value in intestinal indigestion. The acid is 
best used in the form of the officinal dilute acid [Acidum Hydro- 
chloricum Dilutum, TJ. S. and B. P.), dose 10 to 30 drops in water. 

In the sick stomach and for gastric distress following an alcoholic 
debauch, 20 drops of the dilute acid in water are often of service. 

This acid is combined with nitric acid to form dilute nitro-hydro- 
chloric acid (Acidum Nitro-hydrochloricum Dilutum, U. S. and B. P.), 
the dose of which is 10 to 30 minims ; also the pure acid (Acidum 
Nitro-hydrochloricum, U. S). 

Hydrochloric acid causes, when taken in poisonous doses, violent 
gastro- enteritis and corrosion of the gastric walls, and should be 
combated by alkalies, soap, oils, and white of egg. 



HYDROCYANIC ACID. 

Hydrocyanic or Prussic Acid is a transparent, colorless, very vola- 
tile liquid, giving rise to vertigo when slightly inhaled and to death 



172 DRUGS. 

if the fames be concentrated. If the bottle containing the pure drug 
be opened it should be done where there is sufficient draught between 
windows to prevent any contamination of the atmosphere by the 
acid. 

Pure hydrocyanic acid is never used in medicine, but it is em- 
ployed in the form of the dilute acid (Aciclum Hydrocyanicum Di- 
lutum, TJ. S. and B. P.), which contains about 2 per cent, of the 
drug. It must be kept in dark, tightly-stoppered bottles. 

Physiological Action. — This is one of the most rapid, if not the 
most rapid lethal poison known, only being approached by carbolic 
acid. Owing to its volatility it is absorbed with great rapidity, and 
acts upon the respiratory centre and the heart, being eliminated 
almost immediately afterward. As a consequence, the survival of 
a patient twenty or thirty minutes after the ingestion of a dose is a 
favorable sign. 

The drug is an active paralyzant and lethal agent to every part of 
the body. The nervous system, heart, respiration, brain, and all 
parts are killed by it at once if much of it is present. 

Poisoning. — Death either comes on at once, so that the person 
drops dead to the floor with a gasp, is for a moment convulsed, the 
face cyanotic, the eyes wide open, with the teeth tightly shut, and 
the lips covered by a bloody froth, or, three stages of poisoning may 
ensue if the dose has not been very large. In the first of these there 
is difficult respiration, slow cardiac action, and disturbed cerebration. 
In the second stage, which is convulsive, we find wild cries, dilated 
pupils, unconsciousness, vomiting, spasmodic urination and defeca- 
tion, erections of the penis and ejaculations of semen. In the third 
stage there is asphyxia, collapse, and paralysis, ending in death. 
The blood is found to be dark, and venous-looking, but does not give 
the spectrum bauds of cyano-hsemoglobin. These bands only appear 
when the drug is shaken with the blood outside the body. 

The diagnostic signs of death from prussic acid are the odor on 
the body, the wide-staring eye, the clinched teeth covered with froth, 
and the livid, cyanosed face. If the body be opened the odor of 
hydrocyanic acid is marked, but rapidly passes away. 

The only poisoning resembling this is that produced by nitro- 
benzole or essence of mirbane, which has a somewhat similar odor, 
but which is more permanent the odor remaining in the opened body 
for hours. 

Therapeutics. — Hydrocyanic acid is useful in cases of gastralgia 
of purely nervous origin, and in some cases of nervous vomiting and 
in irritable stomach where, owing to a hypersesthesia of the mucous 
membranes, the taking of food produces discomfort. 

In instable coughs, due to tickling in the throat and bronchi, it is 
very extensively used, and has received high praise by those best 
qualified to judge. On the other hand, it has been claimed that 
owing to the extreme volatility of the drug it only acts for the mo- 



HYOSCYAMUS. 173 

meat, and that a dose every ten or fifteen minutes is necessary to 
produce really any effect. However this may be in theory, prac- 
tically it certainly does relieve cough. In these states the following 
prescription will be found of service: 

R. — Acid, hydrocyan. dil f gj. 

Morphinae sulph. ....... gi\ ij. 

Syrup, pruni virg. . . . . . . f^iij. 

M. — S. Teaspoonful every four or five hours to an adult. 

In enteralgia or neuralgia of the intestines, prussic acid is very 
useful. 

Externally the drug is useful in pruritus and other forms of 
itching skin diseases, and the following formula will be found of 
service in pruritus vulva? : 

li. — Hydrarg. bichlorid. . . . . . . gr. ss. 

Acid, hydrocyanic, dil. ..... fgj. 

Aquae amygdal. amarse ..... fjvj. 

M. — S. Apply to the itching surface with a small rag. 

The same prescription may also be employed in pruritus without 
the bichloride, if so desired. The dose of dilute hydrocyanic acid is 
1 to 5 drops. In certain forms of irritable cough inhalations of the 
vapor ( Vapor Acidi Hydrocyanici, B. P.) are recommended ; it is 
prepared by adding 10 to 15 minims of the diluted acid to 1 fluid- 
drachm of water, which is then placed in a suitable apparatus from 
which the vapor that arises is inhaled. 



HYOSCYAMUS. 

Hyoscyamus, U. S. } or Henbane, is a plant of the northern 
United States and Europe. The leaves (Hyoscyami Folia, B. P.) 
are only used, and from them are obtained two alkaloids, one known 
as hyoscyamine, the other as hyoscine. The first has the same phy- 
siological action as atropine (see Belladonna). The second is quite 
different in its influence over the body. The only marked difference 
in the action of hyoscyamine and atropine is in the mydriasis pro- 
duced by each. While that of atropine lasts, in man, from twelve to 
fourteen days hyoscyamine generally remains for only seven to nine 
days. Owing to the presence of hyoscine in hyoscyamus it is more 
quieting and depressing to the nervous system than is belladonna. 

Therapeutics. — Hyoscyamus is used in every condition indicating 
the employment of belladonna ; or, in other words, wherever local 
spasm, or arterial relaxation exists or where pain is due to spasm. 
It has beeu particularly recommended in nervous cough, in whooping- 
cough, and in colic, and probably is better in its influences in these 



174 DRUGS. 

states than is belladonna. In combination with nitrate of silver the 
extract may be used with advantage in chronic gastric catarrh. In 
urinary incontinence due to irritable bladder it is very serviceable, 
and particularly is this true of children and old persons. 

Administration. — The drug itself is officinal in four forms, and as 
hyoscy amine sulphate. The dose of the tincture (Tinctura Hyos- 
cyami, U. S. and B. P.) is 30 drops to 1 drachm ; the alcoholic ex- 
tract (Extractum Hyoscyami Alcoholicum, U. &), dose 1 to 3 grains ; 
the alkaloid (Hyoscyamince Sulphas, U. S.), dose -g 1 ^- to -^ of a grain ; 
the abstract (Abstractum Hyoscyami, U. S.), dose 2 to 3 grains ; and 
the fluid extract (Extractum Hyoscyami Muidum, U. S.), dose 5 to 
30 drops. The B. P. preparations besides those given are the ex- 
tract (Extractum Hyoscyami), dose 5 to 10 grains, or more, and the 
juice (Succus Hyoscyami), dose 30 minims to 1 fluidrachm. 



Hyoscine. 

This is one of the alkaloids derived from hyoscyamus and is a 
powerful nervous depressant. 

Physiological Action. — Hyoscine quiets the cerebrum and produces 
deep sleep in a certain class of patients. In the lower animals, or in 
man, it may cause sleep or wild delirium. It causes loss of reflex 
action in overdose, which is due to paralysis of the spinal cord and 
not of the nerve-trunks. Upon the circulation it has little effect, but 
it is worthy of note that it does influence the vagus nerves, as does 
atropine, stimulating them at first, and finally paralyzing them, 
although the contrary has been asserted. In any event the circu- 
latory effect is a minor one. 

Therapeutics. — Hyoscine is of value as a hypnotic in a very limited 
class of cases, but in this class generally acts most favorably. This 
class consists of those who, from acute mania, alcoholic mania, hys- 
teria, or similar cause, suffer from insomnia, and perhaps use violent 
struggles against proper control, or refuse to swallow or retain food. 

The drug may be given to such persons hypodermically, in the 
dose of y 1 -^ to g 1 ^ of a grain, or by the mouth in the dose of -§-$■ to 
-^q of a grain. The fact that it possesses no taste, and is small in 
bulk, also renders it ready of employment. In some cases it utterly 
fails, even in this particular type of cases. 1 In delirium tremens it 
may cause evidences of cerebral congestion and Cheyue-Stokes 
breathing. 

Hyoscine is of great value in spermatorrhoea and nocturnal emis- 
sions. 

1 The writer has given one-tenth of a grain of Merck's hyoscine in twenty-four 
hours, obtained from two different and reliable stores, without producing sleep, although 
the respirations were much quickened. 



IRON. 175 

The drug is contra- indicated in the sore-throat of scarlet fever, as 
it may cause glottic spasm. In the insomnia of heart disease with 
nervousness it will cause sleep, but may also produce death by respi- 
ratory failure or cardiac arrest, and it is to be remembered that the 
drug will produce asthma rather than relieve it. The breathing, in 
ordinary cases, may become croupy or rasping. 



ICHTHYOL. 

Ichthyol is a substance obtained by distillation from a peculiar 
resinous deposit found chiefly in the Tyrol, and supposed to be the 
result of a deposit of extinct fish. Ichthyol occurs as the ichthyo- 
sulphate of sodium or ammonium. Both of these contain about 10 
per cent of sulphur and it is largely upon this that their therapeutic 
activity depends. 

Therapeutics. — Ichthyol is without doubt one of the most remark- 
able substances used for medicinal purposes which has appeared in the 
last decade. In skin diseases it has been most highly recommended 
on both sides of the Atlantic, and is employed in form of ichthyol 
ointment in chronic eczema, acne, urticaria, and even on lupus and 
keloids. In almost all chronic skin affections it is of the greatest 
value, and the writer has seen it exert a most favorable influence 
upon erysipelas in hospitals and in his private practice. Under 
these circumstances the ointment should contain about 20 per cent, 
of ichthyol, or less. It has also been found by the writer most effi- 
cacious in the pain and swelling accompanying acute rheumatism of 
the joints, both during and after the acute stage of the disease. The 
strength for this use should be about 30 per cent, of ichthyol to 70 
of beuzoinated lard. In frost-bite, chilblains, and in burns it is of 
service, and Agnew has recommended it highly when rubbed into 
lymphatic enlargements. 

For acute sprains, and for the removal of the swelling following 
such injuries, its influence is extraordinary if it be well rubbed into 
the part affected. 

IRON. 

Iron (Ferritin, U. 8. and B. P) is a metal and a food. A food 
because it forms part of the body when taken into the organism and 
is used by the system in the making of blood. The number of 
its officinal salts and compounds is absurd, and half the list is 
rarely, if ever, used. 

Physiological Action. — Iron has little or no effect upon the system 
when given in a single dose, but repeated doses cause an increase in 



176 DRUGS. 

the number of red blood-corpuscles, plethora, or an increase in the 
quantity of the blood. Iron is eliminated from the system by the 
liver, and perhaps by the kidneys. If given in excessive doses it is 
changed into the sulphide and escapes with the faeces. It has been 
asserted that it is never released from the body, but this is untrue. 
Whether it acts as a stimulant to blood manufacture, or simply sup- 
plies the glands with blood-making material, we do not know. Iron 
probably increases the activity of the body to some extent, and 
thereby causes oxidation to go on more rapidly by reason of its 
peculiar power of converting oxygen into ozone. The studies of 
Skvortzoff are interesting in connection with this subject. He found : 
1. That iron has no marked influence on nitrogenous metamor- 
phosis in the healthy body. 2. The ingestion of iron in daily 
doses of 0.02 to 0.03 gramme (0.3 to 0.5 grain) causes a very slight 
decrease in the assimilation of the nitrogenous portions of the food. 
3. After bleeding the assimilation of nitrogenous substances increases 
a little, whether iron is used or not; but if iron is used at this time 
the haemoglobin is rapidly reproduced, and the drug would seem to 
be of value in restoring the bodily weight. 

The preparations of iron consist in the soluble and insoluble salts 
or forms. Of these the insoluble are probably better than the soluble, 
but this is by no means to be thought a recognized fact. 

Therapeutics. — The chief indication for iron is anaemia (see 
Anaemia), and its contra-indication is plethora. When used in small 
doses, J to 1 grain, it is quite as efficacious as in large amounts and 
less apt to disorder the stomach. It should not be used as a tonic 
unless some direct indication for its employment is present, and no 
drug is more abused in this respect than iron. As each of its prepa- 
rations possess some peculiarity the use of each will be considered 
separately. 



Reduced Iron. 

Quevenne's iron (Ferrum JRedactum, U. S. and B. P.) is an iron gray 
or reddish powder which is frequently adulterated with lampblack. 
If it is pure it should burn in sparks when dropped into a flame, 
but if lampblack is present this will not occur. It should also 
yield no sulphuretted hydrogen on adding sulphuric acid to it. It is 
tasteless, and may be given to children for this reason in pills or gum- 
drops or placed inside of small chocolate creams or in the form of 
Troches (Trochisci Ferri Redacti, B.P.), each lozenge containing 1 
grain of the reduced iron. It is used solely in anaemia and is one of 
the least astringent of the iron preparations. 



SULPHATE OF IRON. 177 



Chloride of Iron. 



Tincture of the chloride of iron (Tinctura Ferri Chloridi, XI. S.) y 
often called tincture of the muriate of iron, is oue of the best and most 
useful preparations of iron that we have. It is the most diuretic 
preparation of iron. This diuretic effect does not depend upon 
the presence of a muriatic ether as has heretofore been taught, since 
hydrochloric ether is not present and is hard to prepare, except 
there be au excess of chlorine present. According to some researches 
of Dr. S, Weir Mitchell, the only ether present is nitrous ether, and 
this is devoid of power and in small quantity. As chloride of iron 
itself is diuretic, it is probably upon this that the diuresis produced 
by it depends. The dose of the chloride of iron (Ferri Chloridum, 
XT. S.) is 1 to 3 grains. Tincture of the chloride of iron is con- 
sidered a specific in erysipelas and should be given in very full 
dose and frequently repeated if it is to be of any service. Ten 
drops every hour is not too much. In chronic Bright 7 s Disease it 
is of value and decreases the albuminuria. In anoemicc it is useful, 
and owing to its acid is a doubly effective tonic. In cases of slight 
anaemia in which very great arterial pressure exists Dr. Mitchell 
uses a purely milk diet, and an ounce of an old tincture of iron in 
the twenty-four hours. While he recognizes the fact that iron prep- 
arations are generally supposed to raise blood-pressure, he asserts 
that in this instance the blood-pressure is lowered. Liquor Ferri 
Perchloridi, B. P., and Tinctura Ferri Perchloridi, B. P., are used 
internally in the dose of 10 to 30 minims. 

As a local application tincture of the chloride of iron is useful in 
diphtheria and membranous croup and even in tonsillitis. In this last 
malady large doses of the tincture internally with counter-irritation 
over the neck is most useful. When used internally it should be 
well diluted and taken through a glass tube to protect the teeth. 
The strong solution of perchloride of iron (Liquor Ferri Perchloridi 
Fortior, B. P.) is a powerful styptic. 



Sulphate of Iron. 

Sulphate of iron (Ferri Sulphas, XI. S. and B. P.) is used inter- 
nally in the dose of 5 grains in pill form in chronic diarrhoea. Ex- 
ternally in a solution of the strength of 5 to 25 grains to the ounce it 
is used as an astringent lotion. Two other forms of the sulphate 
are also employed, namely, the dried (Ferri Sulphas Exsiccatus, XI. 
S. and B. P.) and the precipitated (Ferri Sulphas Prcecipitatis, XI. S.) 
(Ferri Sulphas Granulata, B. P.), each of which is given in the dose 
of 3 grains. 



178 DRUGS. 



Iodide of Iron. 



The syrup of the iodide of iron (Syrupus Ferri lodidi, JJ. S. and 
B. P.) is a transparent liquid of a sweet, iron-like taste. It should 
contain no free iodine, and if it strikes a blue color with starch 
should be discarded. It is largely used in anaemia associated with 
scrofulosis and struma, and is useful in the eczema of young children 
when this is dependent upon lack of vitality and anaemia. The dose 
to a child of two years is 2 to 3 drops well diluted, and to an adult 
30 to 40 drops in water, to be taken through a glass tube to protect 
the teeth. 

The saccharated iodide of iron (Ferri Iodidum Saccharatum, IT. 8.} 
is used in place of the syrup in the dose of 2 to 5 grains in pill 
(Pilula Ferri lodidi, U. S. and B. P.), each contains ^ of a grain of 
reduced iron and ^ of a grain of iodine, and are given in the dose 
of 1 to 3 pills. 

Carbonate of Iron. 

The carbonate of iron (Ferri Carbonas Saccharatus, U. S. and 
B. P.) is very slightly astringent and may be used in pill form under 
the name of Pilulce Ferri Composites, U. S. y or in Griffith's pills, which 
also contain myrrh. The dose is 3 grains, and they are largely used 
in amenorrhoea dependent upon anaemia. Under the name of Mistura 
Ferri Composita, U. S. and B. P., we have a liquid preparation used 
for the same purposes as the pills in the dose of 1 to 2 tablespooufuls. 
Pilula Ferri Carbonatis, B. P., are given in the dose of 5 to 20 
grains. 

Monsel's Solution. 

Monsel's Solution (Liquor Ferri Subsulphatis, U. S.), sometimes 
wrongly called the persulphate of iron, is one of the most powerful 
styptics or haemostatics that we have. It is never to be employed 
where a haemorrhage is to be attacked through the circulation, but only 
when the solution can come in direct contact with the bleeding spot. 
The objection to its use is the heavy, black, and dirty clot which it 
forms. In haemoptysis Monsel's Solution should be used in fine spray 
consisting of from 10 to 60 drops to the ounce of distilled water. In 
uterine haemorrhage from any cause the dilution may be half and 
half, or if the haemorrhage be from a polypus or the cervix uteri the 
pure solution should be used, locally applied. In nose-bleed Monsel's 
Solution may be employed diluted one-half or pure, but it is disa- 
greeable because of the hard, black clot which is formed and the 



DIALYZED IRON. 179 

disagreeable seosatioDS produced in the nasal chambers. Plugging 
with pledgets of cotton is generally sufficiently efficacious. 

In the intestinal hemorrhage during typhoid fever MonsePs Solu- 
tion has been, but ought not to be, given, as it is decomposed in the 
stomach before it reaches the intestine. 

MonsePs Salt {Ferri Subsulphatis) should be given in pills of 3 
grains each, the pills being made hard enough to escape into the 
intestine before the stomach breaks them down. One, two, or three 
pills may be given and repeated in an hour. Hwmatemesis due to 
bleeding in the stomach should be treated by 3-drop doses of the 
solution in a little water. 

In tonsillitis and pharyngitis a most efficient application is pure 
MonsePs Solution on a pledget of cotton or camels'-hair brush ; or 
equal parts of the solution and glycerin may be used. The applica- 
tion is often as painful as it is efficient. In diphtheria this method 
of treatment is often of great service. The antidote to MonsePs 
Solution is common soap. 



Hydrated Sesquioxide of Iron. 

Hydrated Sesquioxide of Iron [Ferri Oxidum Hydratum U. S.) is 
the antidote to arsenic, and to be efficacious it must be freshly pre- 
pared. It is to be made by precipitating any liquid preparation of 
iron by the addition of an alkali such as ammonia, or the addition of 
magnesium. If ammonia is used, the precipitate has to be washed 
with water several times to get rid of the alkali, which will be too 
irritant to swallow if present. Magnesium is itself antidotal and 
should be preferred. The antidote should be given in excess and 
as much as a pint of the iron solution should be precipitated. The 
magnesium should be freely added, as too much of it cannot be given. 
The officinal antidote to arsenic is Ferri Oxidum cum Magnesio, U. 8. 

In the Pruss'ian Phamacopceia this is known as the Antidotum 
Arsenici. 



Dialyzed Iron. 

Dialyzed Iron [Ferri Dialyzatum) is a very feeble preparation of 
iron, lacking in astringency, easily precipitated from the solution in 
which it occurs and largely used in anamia by some practitioners. 
The dose is 10 to 20 drops in water three times a day. Sometimes 
river water will precipitate it. Owing to its unstableness it may be 
used without any preparation as an antidote to arsenic. Liquor Ferri 
Dia lyzatus, B. P., is given in the dose of 10 to 30 minims. 



180 DRUGS 



Citrates of Iron. 



The four citrates of iron are soluble in water and very useful for 
this reason. Ferri Citras, U.S., and Ferri et Ammonii Citras, U.S. 
and B. P., occur in garnet-red scales and are given in the dose of 5 
grains. The solution of the citrate of iron {Liquor Ferri Citratis, 
U. S.) is given in the dose of 10 minims. The Ferri et Quinince 
Citras, U. S. and B. P. , and the Ferri et Strychnines Citras, U. S. 
and B. P., are given in the dose of 5 to 15 grains and 1 to 3 grains 
respectively. The solution of iron and quinine (Liquor Ferri et 
Quinince Citratis U. S.) is given in the dose of 8 to 15 minims. 

The bitter wine of iron ( Vinwn Ferri Amarum, U. S.) is composed 
of the solution of the citrate of iron and quinine, sweet orange peel, 
syrup and stronger white wine, and is given in the dose of 1 to 2 
fluidrachms. 

Beside these citrates there are two tartrates — Ferri et Ammonii 
Tartras, U. S., and Ferri et Fotassii Tartras, U. S. ; Ferrum Tcirta- 
ratum, B. P., both given in the dose of 5 grains. The lactate of 
iron (Ferri Lactas, U. S.) is soluble in forty-eight parts of water and 
given in the dose of 5 grains. Lactate of iron is one of the ingre- 
dients of Syrupus Hypophosphitum cum Ferro, U. S., the dose of 
which is A- to 1 fluidrachm. 



2 



Valerianate of Iron (Ferri Valerianae, U. S.) is sometimes useful 
in hysteria with anaemia, given in the dose of 1 grain or more. 

Oxalate of iron (Ferri Oxalas, U. S.) is given in the dose of 2 to 
3 grains. 

Hydrated peroxide of iron (Ferri Peroxiclum Hydralum, B. P) 
is used in the dose of 5 to 30 grains. From the last preparation 
iron plaster (Emplastrum Ferri, B. P.) is made. The plaster of iron 
officinal in the U.S. is prepared from the hydrated oxide of iron. 

The following preparations of iron are also officinal : Liquor Ferri 
Acetatis, U. S., dose 15 minims to 1 fluidrachm ; Liquor Ferri Ace- 
tatis Fortior, B. P., dose 1 to 8 minims ; Mistura Ferri et Ammonii 
Acetatis, U. S., dose J to 1 fluidounce. 



Phosphates of Iron. 

There are two phosphates of iron, Ferri Phosphas, U. S. and B. P., 
and Ferri Pyrophosphas, U. S. The first of these is insoluble and 
is rarely used. The second is quite soluble and useful in the dose of 2 
to 5 grains. Syrupus Ferri Phosjihatis, B. P., is given in the dose of 
1 fluidrachm. Phosphate of iron is one of the ingredients of the 
syrup of iron, quinine, and strychnine (Syrupus Ferri, Quinince et 
Strychnince Phosphatum, U. S.), given in the dose of 1 fluidrachm. 



AROMATIC MIXTURE OF IRON. 181 

Ammonio-ferric Alum. 

Ammonia-ferric Alum (Ferri et Ammonii Sulphas, U. S.) is often 
given in atonic leucorrhcea in the dose of 2 to 5 grains. It is quite 
astringent. 

Arseniate of Iron. 

Arseniate of iron (Ferri Arsenias, B. P.) is used in the dose of 
T¥ *° tV g ra i n m anaemic subjects with skin diseases. 



Bromide of Iron. 

Bromide of iron (Ferri Bromidum) is said by Da Costa to be useful 
in anosmia with chorea in the dose of 5 to 20 grains in syrup. In 
other nervous diseases accompanied by anaemia and insomnia the 
syrup of bromide of iron (Syrwpus Ferri Bromidi, TJ. S.) is useful 
in the dose of J to 1 fluidrachm. 

Wine of Iron. 

The Wine of Iron (Vinum Ferri, B P.) is useful in anosmia, both 
in children and adults, and may be accompanied with cod-liver oil. 
It is given in a dose of 1 to 2 fluidrachms or more. 



Aromatic Mixture of Iron. 

The Aromatic Mixture of Iron (Mistura Ferri Aromatica, B.P.) 
contains so little iron that it should not be administered in cases 
where a chalybeate influence is desired ; it is, however, a useful 
tonic, given in the dose of 1 to 2 fluidounces. 

Untoward Effects of Iron. — Iron is apt to cause gastric distress 
and frontal headache in persons who are susceptible to its use. Even 
one dose will cause this trouble in some persons. In many instances 
the frontal headache will be found to be due to the constipation 
brought on by the iron and will be relieved if mild laxatives or 
purges are used. Indeed, the state of the bowels should always be 
watched and laxatives given whenever constipation is present. In 
rheumatic and gouty persons frontal headaches are a common symp- 
tom under iron and purgatives will not generally give relief. Some- 



182 DKUGS. 

times salts of iron cause vesical irritation and constant desire to 
urinate, while mucus in abnormal amount forms in the bladder. In 
children its use may result in nocturnal incontinence of urine. 

Incompatibilities. — Iron should not be used with any vegetable 
astringent containing taunic or gallic acid as it will make an ink. 
Alkalies and their carbonates are also incompatible with iron, as is 
gum-arabic, with which it forms a dark, gummy mass or jelly. 



IGNATIA. 

Ignatia, U. S., or Ignatia bean, is the seed of the Strychnos Ignatia. 
It contains two alkaloids, strychnine and bruciue, as does nux vomica. 

Physiological Action. — Its physiological action is identical with 
that of strychnine or nux vomica. 

Therapeutics. — (See Nux Vomica.) The abstract of ignatia (Ab- 
stractum Ignatice, U. S.) is given in the dose of 1 grain ; the tincture 
(Tlnctura Ignatice, U.S.) in the dose of 15 minims to \ fluidrachm. 



IODIDE OF AMMONIUM. 

Ammonii lodidwm, U. #., is used in the same doses and for the 
same purposes as the iodide of potassium. It is preferred by some to 
the latter salt when the respiratory or digestive tracts are involved. 



IODIDE OF POTASSIUM. 

The physiological effects of iodide of potassium (Potassii Iodidum, 
U. S. and B. P.) are entirely comparable to those of iodine itself, 
but it is employed for somewhat different purposes, is less irritant, 
more readily given, and perhaps more readily absorbed. 

Therapeutics. — The use of iodide of potassium may be divided 
into three great divisions, each of which is important. It is also 
employed for many conditions not included in these classes. 

1. Syphilis. — The use of iodide of potassium in syphilis is recog- 
nized as a part of all treatment for its relief. Elsewhere Dr. Martin 
has, in his excellent article, treated of this question, and it is only 
necessary here to call attention to the fact that the drug is generally 
well borne in large amounts by advanced syphilitics, although this is 
not always the case. The term " therapeutic test" is applied by one 
eminent teacher to signify a state of the system produced by syphilis 
in which a diagnosis may be made, by the fact that large doses of the 
iodide are borne without inconvenience. As already intimated, this 
resistance does not always prove the presence of syphilis, nor does 



IODIDE OF POTASSIUM. 183 

its absence prove the absence of this disease. Persons having 
hereditary asthma, gout, rheumatism, or some similar diathetic dis- 
ease, often resist the iodide, and some syphilitics are affected with 
"iodism" after very small doses. In treating syphilis the drug 
should be used in the dose of 10 grains three times a day, gradually 
increased a grain a day until symptoms of "iodism" occur. 

The quantity borne often amounts to 60 or 90 grains a day. The 
best way to use it is to order for the patient a saturated solution of 
the iodide, which contains in each drop about 1 grain, and at the 
same time a bottle of the compound syrup of sarsaparilla. To a 
tablespoonful of this the patient is to add the iodide solution, begin- 
ning with 10 drops three times a day and increasing a drop every 
twenty-four hours. 

The iodide acts more slowly as an anti-syphilitic than does mercury. 

In tertiary syphilis the remedy is invaluable. 

In nervous syphilis, be its manifestations what they may, iodide of 
potassium is the standard remedy, only being supplanted by mercury 
when it is necessary to resolve a growth whose existence is a daily 
menace to the patient's life. 

2. Metallic Poisoning. — Owing to the fact that iodide of potas- 
sium forms double soluble salts with all the metals in the tissues in 
chronic poisoning, thereby aiding in their elimination, it should 
always be employed in chronic lead, zinc, arsenic, or mercurial poi- 
soning. 

3. Anti-rheumatic. — Iodide of potassium is best suited, not 
to the acute sthenic stages of rheumatism when the joints are very hot 
and painful, but to the secondary or subacute periods when the joints 
are large and the case " hangs on" — now better, now worse. It acts 
best, under these circumstances, if combined with wine of colchicum- 
root (see Rheumatism). It is also to be tried in sciatica, lumbago, 
and rheumatic neuralgia, and should be employed in chronic pleurisy, 
pericarditis, and hydrocephalus, to cause absorption of the fluids. 

In aneurism, particularly that of the aorta, the drug does good, 
but its value rests largely upon the cause of the disease, which, if it 
is syphilis, yields much more rapidly to the drug than if it is not. 
The pain, swelling, and pulsation generally decrease. 

In asthma iodide of potassium is valuable if it is of the bronchial 
type, but ought not to be employed if it is gastric. In bronchitis 
aud intestinal catarrh where the state is semi-chronic, and not 
relieved by chloride of ammonium, iodide of potassium should be 
used. If the bronchitis is chronic and the secretion profuse (bron- 
chorrhoea) iodide of potassium will make it worse. The dose for an 
adult in all these instances should be about 3 to 5 grains three times 
a day. 

In chronic nephritis small doses (5 grains t. d.) are thought by 
some to check the disease, but it is to be remembered that the drug 
may produce poisoning if the kidneys do not eliminate it, so that, if 



184 DRUGS. 

used at all, it must be employed with great care. If the drug is well 
borne it will cause an extraordinary increase in urinary flow, and 
will relieve the dropsy which may be present very rapidly indeed. 

In bronchocele iodide of potassium internally, and tincture of 
iodine externally is the best treatment we can use, and in acute coryza, 
or "cold in the head," 10 grains of the iodide taken at the begin- 
ning of the trouble will often abort the attack. 

In hepatic cirrhosis, in the early stages, the iodide often does good, 
and in arteriosclerosis, or atheroma of the bloodvessels, it is of great 
service according to many English, French, and American writers. 

A very important use of iodide of potassium is in the removal of 
enlargements of the cervical glands and those occurring in other parts 
of the body. In enlargements of the spleen, malarial or otherwise, 
external paintings with iodine and the internal use of the iodide in 
small doses are of service. In the later stages of pneumonia the 
iodides are useful to aid in the absorption of any exudates, but they 
are contra-indicated in phthisis, except in the fibroid form and in 
some cases of the syphilitic variety, as they aid in the breaking down 
of the lung. 

Untoward Effects. — In some persons, after the use of the iodide, 
coryza with a tearful condition of the eyes comes on, so that the 
edges of the lids become reddened and the nose runs constantly. 
This is followed, if the drug is pushed, by the more positive signs 
of " iodism " spoken of under Iodine. 

In others acne breaks out on the face and disorders of digestion and 
gastric irritability come on. The acne can nearly always be pre- 
vented by employing arsenic at the same time with the iodide. In 
some cases petechial rashes break out on the legs, while in others 
great mental and physical depression appear, so that listlessness or- 
melancholia may develop. 

Sometimes the iodide of ammonium or iodide of sodium will be 
borne when the iodide of potassium will not. 

If bullae or blebs follow the use of iodides, or other rashes appear, 
it is said that atropine will afford relief. 

Administration. — The iodide, owing to its exceedingly disagree- 
able taste, should be given with the compound syrup of sarsaparilla, 
extract of licorice, or in milk. Large amounts of these vehicles are 
to be used. 

One of the best ways to take it is in capsule, but if this is done a 
drink of milk or water or other fluid should precede and follow it, in 
order to prevent the drug from coming in contact with the stomach in 
concentrated form. The preparations of the iodide of potassium are : 
(TJnguentum Potassii lodidi, TJ. S. and B. P.), and the liniment 
(Linimentum Potassii lodidi cum Sapone, B. P.). 



IODINE. 185 

IODIDE OP SODIUM. 

Sodii lodidum, U. S. and B. P., is used in the same doses and for 
the same purposes as the iodide of potassium. 



IODINE. 

Iodum, U. S. and B. P., is a non-metallic element found largely 
in sea-weed and in mineral iodates and iodides. It is soluble in 
ether and alcohol, but slightly so in water, and possesses an acid 
burning taste and a neutral reaction. 

Physiological Action. — The physiological action of iodine, so far 
as its alterative powers are concerned, is absolutely unknown. 
Applied to the skin it stains it yellow, brown, or black according to 
the freedom of its application, and it acts without pain if the skin is 
intact. If very large amounts are used it produces vesication. Upon 
mucous membranes it acts as a powerful irritant. Germain See 
believes it to be a stimulant to the nutritive processes of the body 
and to the circulatory system, and is certainly correct in regard to 
the first part of his belief. 

Elimination. — The drug escapes chiefly through the kidneys 
and through the skin, the salivary glands, and in the milk of nursing 
women. 

Poisoning. — The symptoms of acute poisoning are those of acute 
gastro-enteritis with severe pain in the oesophagus, stomach, and 
abdomen, and is accompanied by violent vomiting and purging. An 
early symptom is the persistent, strong metallic taste in the mouth 
with markedly increased salivation. The pulse becomes rapid, run- 
ning and feeble, the face deathly pale, total arrest of urinary secre- 
tion takes place through renal irritation, and death occurs by failure 
of respiration, which is accompanied by loss of all vital power. 

If the poisoning is not severe enough to cause death at once a 
fatal result is often attained, by reason of a widespread fatty degen- 
eration of the tissues. 

The treatment consists in the use of large amounts of starch in 
any form as the antidote, the employment of emetics and the 
stomach-pump, the application of heat to the body and extremities, 
and, finally, the employment of hypodermic injections of alcohol, 
digitalis, ammonia, and atropine or strychnine. 

Chronic Poisoning. — Under the name of "iodism" the profession 
recognizes a state of the body brought on by the prolonged and ex- 
cessive use of iodine in some of its forms. The earliest signs of this 
state are shown by a peculiar metallic taste in the mouth, particu- 
larly before breakfast, slight tenderness of the teeth and gums, in- 



186 DRUGS. 

crease of salivary secretion, a little morning nausea and lack of 
appetite for breakfast, and perhaps some coryza or evidences of gas- 
tric irritation. Acne rosacea often comes on very early. If the drug 
is continued, all these symptoms become more marked and the coryza 
becomes intense. Headache under the frontal bone and sore-throat 
often appear, and the pustular and bleb-like changes in the skin 
go on to active suppuration. Sometimes large boils appear, or 
purpura hemorrhagica comes on. 

In other cases the nervous system chiefly suffers. Twitchings of 
the muscles, neuralgic pains in the trunk and extremities, and wast- 
ing of the testicles, mammae, and all other tissues occur as the result 
of trophic disturbances. Anaemia amounting to an actual cachexia 
is commonly produced. Loss of vision and paralysis may ensue. 

Therapeutics. — In all cases where the system is in a state of 
chronic perverted functional activity, as in those diseases associated 
with processes of nutrition and known as scrofidosis, iodine is of ser- 
vice. In enlargement of the lymph glands it is, in its various forms, 
one of the best remedies we possess, but it ought not to be employed 
in those cases where rapid changes are going on in the gland, such 
as the formation of pus, since under these circumstances it will in- 
crease the size of the slough. The drug ought never to be used in 
phthisis for these reasons, except in the exceedingly chronic form 
known as fibroid phthisis. When inhaled in fumes it may be of ser- 
vice as a stimulant to the mucous membranes, but is never of value 
in phthisis otherwise. In countries where exophthalmic goitre is very 
prevalent iodine ranks as a most efficient remedy. In cystic enlarge- 
ment of the thyroid gland it is valueless, but in simple hypertrophy 
it is of great value. 

In chronic bone disease iodine applied about the affected joint in 
the form of the ointment diluted one-half with lard, or the pure 
tincture, will be found of service, and if anwmia exists the syrup of 
the iodide of iron should be given internally. 

The other uses of iodine externally are many and important. As 
a slow counter-irritant, devoid of pain, it is particularly useful in 
children, and may be employed in 1 to 3 coats, and no more. 

The proper way of using the tincture is to give one good black coat 
at one sitting, and not to repeat it until the skin has desquamated and 
become well renewed. If iodine is applied soon after one good, 
effective coat it will cause agonizing burning pain, which nothing 
will relieve except the removal of the iodine by the use of cologne- 
water, alcohol, whiskey, or gin. The latter causes such an increase 
in the pain as to be almost useless after the skin is broken. The 
best solution for its removal is one of iodide of potassium, which 
should be followed by a poultice. A good rule to follow is never to 
cause pain by the use of iodine, as the drug acts equally well if 
applied in such a way as to avoid suffering. 

Iodine in the form of the tincture is applied as a counter-irritant 



IODINE. 187 

paint in pleurisy, both to abort an attack and aid in the absorption 
of the fluid after it is thrown out into the chest. In harassing 
irritative cough it may be painted over the supra-clavicular spaces, 
and will lessen the secretion in chronic bronchitis if used in this 
way. In chronic rheumatism of the joints and muscles it does good 
locally applied. Often in synovitis the local application of iodine 
causes increased swelling for some days. This should not cause 
alarm, for ultimately the swelling decreases very greatly, and these 
cases are generally the best from a prognostic point of view. 

In the course of phthisis every now and then a "spot" in the 
chest will become " sore/' probably due to a limited area of pleurisy, 
and tincture of iodine applied locally will give relief. In lupus the 
tincture may be painted around the edges of the growth, and even 
over its surface, with the object of retarding its spread. In chilblains 
the iodine ointment gives the greatest relief if diluted one-half with 
lard, and is probably the most efficacious measure at our disposal. 
In certain individuals who have "pains in the chest" iodine oint- 
ment may do good if applied over the spot. As has been pointed out 
by others, iodine does good if muscular tenderness is present, while it 
fails if pleurodynia or intercostal neuralgia is the cause of the suffering. 
The latter should be removed by the use of belladonna. In certain 
forms of skin diseases, such as tinea tonsurans and circinata, tincture 
of iodine applied with a camel's-hair brush may be used, even the 
entire scalp being covered. The better way is to apply it to different 
spots each day. Where erysipelas is present the tincture may be 
painted around the edges of the inflammation, in order to prevent 
its spread. 

In old persons, or those in middle life, retraction of the gums from 
the teeth sometimes comes on, and Stille recommends for this disorder 
the use, by means of a camel's-hair brush, of a watery solution of 
iodine of the strength of 1 grain to the ounce, to be followed at once by 
a thorough rinsing of the mouth with pure water. In hydrocele iodine 
in the form of the tincture is the best remedy for effecting a perma- 
nent cure that we have. The sac should first be emptied by the use 
of a trocar and canula and the iodine alone, or with glycerin, injected 
with a syringe, and then allowed to escape. As the pain is most 
atrocious, the patient should be put partly under the influence of 
ether. 

In white swellings and ovarian tumors as much as 10 ounces of the 
tincture may be injected, but it is to be remembered that certain dan- 
gerous symptoms may arise, at least after its use in this way in the 
chest. These consist in epileptiform convulsions, coma or collapse. 

In empyema a solution of iodine 6 grains, iodide of potassium 6 
grains, and water 1 pint, may be used daily as an irrigating fluid 
with good results. The tincture of iodine may be used, according to 
Ringer, as an inhalation, with signal benefit in the four following 
instances : 



188 DRUGS. 

1. In the chronic forms of phthisis {fibroid lung) ; when the expec- 
toration is abundant, and when the cough is troublesome, its inhalation 
used both night and morning will generally lessen the expectoration 
and allay the cough. 

2. In children six to ten years of age, who after meals, or inde- 
pendently of them, on exposure to cold, are seized with hoarseness, 
a hoarse, hollow cough, and some wheezing at the chest. This affec- 
tion involves the larynx, trachea and larger bronchial tubes, often 
proves very obstinate, is apt to return, and to persist a considerable 
time. 

3. In some epidemics of diphtheria the inhalation recommended 
by Dr. Waring-Curran is of value, and consists of 4 grains of iodine 
and 4 ounces of water. A teaspoonful of this should be added to boil- 
ing water, and kept hot by a spirit lamp, whilst the steam is inhaled. 
As the patient becomes accustomed to the iodine the quantity of the 
solution may be increased till half an ounce of it is used at each in- 
halation. It should be repeated many times a day, and each inhala- 
tion continued from 8 to 12 minutes. 

4. Some persons suffer with itching of the nose, of the inuer canthus 
of one or both eyes, sneezing, running at the nose of a watery fluid, 
weeping of the eyes, and severe frontal headaches, and these patieuts 
of various ages are greatly troubled, often for many years, with daily 
attacks lasting, it may be, several hours. Iodine inhaled often re- 
moves this affection at once, and when it succeeds partly it almost 
always lessens the headache and discharge from the nostrils. Its 
effect is most marked in respect to the itching. 

Ringer generally adopts the following simple, handy, cleanly, and 
effectual plan of inhalation : Heat well a jug capable of holding 
about two pints, by rinsing with boiling water, then partly fill with 
boiling water into which pour 20 to 30 drops of the tincture of 
iodine, then direct the patieut to put his face over the mouth of the 
jug and to breathe the iodized steam, covering the head to prevent 
the escape of the steam. This inhalation should be used night and 
morning for five minutes, or a little longer. Occasionally an excess 
of iodine will temporarily produce a sensation of soreness in the 
chest and throat, sometimes with redness of the conjunctiva, running 
from the nose, and pain in the head. 

Administration. — Iodine is never used in solid form, and it has 
been taught that the tincture (Tinctura Iodi, U. S. and B. P.) should 
not be given internally, on the ground that it is precipitated in the 
stomach. Whether this be true or false it is a fact that the tincture 
has recently been largely used in the vomiting of pregnancy with 
very good results. The dose is 5 to 10 drops, well diluted. Under 
the name of LugoPs Solution {Liquor Iodi Compositus, U. S.) iodine 
is frequently used internally ; the dose is 5 to 10 drops, in water. 
The B. P. preparations not officinal in the U. S. P. are the liniment 
{Linimentum Iodi), the solution {Liquor Iodi) and Vapor Iodi, which 



IODOFOKM. 189 

is prepared by adding 1 fluidrachm of iodine to 1 flnidonnce of water, 
which is gently heated, and the rising vapor inhaled. 

Unguentum Iodi, U. S. and B. P., is used locally over enlarged 
glands. In the case of children or adults who have delicate skins 
the ointment should be diluted one-half with lard. 

Iodine is contra-indicated in renal diseases, except in small doses, 
in the progress of acute inflammation, and wherever tissues are rap- 
idly undergoing degenerative changes. 



IODOFORM. 

Iodoform (Iodqformum, U. S. and B. P.) occurs in small saffron- 
colored crystals which possess a powerful, characteristic, penetrating 
odor, and strong taste. It is soluble in alcohol, ether, chloroform, 
benzol, fixed and volatile oils, but is insoluble in water. 

Physiological Action. — When iodoform is absorbed from the 
stomach, or the skin from surgical dressings, it induces a train of 
serious and curious symptoms. Within half an hour iodine appears 
in the urine, and the symptoms assert themselves in one or two ways. 
One set of symptoms resembles meningitis. The face is suffused, 
the pupils contracted, the respiration stertorous, and the pulse slow 
and full, or rapid. Delirium of the wildest character may ensue so 
that the patient tears everything within reach. In another class of 
cases the symptoms resemble those of cerebral congestion in the 
flushed face, contracted pupils, slow breathing, low muttering de- 
lirium or perfect vocal quiet. After death widespread fatty degen- 
eration is found at the autopsy. 

The resemblance of the symptoms to cerebral congestion or menin- 
gitis should not mislead the physician into the belief that any head 
injury is present when a limb has been dressed with iodoform after 
an accident. 

Locally applied the drug possesses very distinct anaesthetic power. 

Therapeutics. — Iodoform is used chiefly as a surgical dressing. 
It is antiseptic, but not germicidal. Germs may be found in pow- 
dered iodoform, and will even grow in it. It does good by ab- 
sorbing the liquids of the wound, and thereby removing the nidus 
for germ growth ; and when applied to large moist surfaces gives off 
free iodine and acts as a protective. 

In syphilitic sores the following dressing will be found of great 
service : Iodoform, 20 grains ; oil of eucalyptus, J fluidounce. In 
eczema, with tingling and itching, the following application will 
give relief (Ringer) : ■ 

R. — Iodoform. . . . . . . „ . gr. iv. 

Oleum eucalypti . . . . . . • 7>]- 

Unguentum petrolei . . . . . • jfj* 

M. S. — Apply locally. 



190 DRUGS. 

Internally iodoform is used in tertiary syphilis in all its forms, in 
the dose of from 1 to 5 grains. Bartholow recommends it most 
highly in catarrhal jaundice and in the early stages of hepatic cir- 
rhosis ; indeed, he thinks its persistent use in small dose will cure 
this affection. 

Used by means of a powder-blower it will often relieve the 
hoarseness and discomfort of laryngeal phthisis. Sometimes a spray 
may be used, which should consist of spirits of turpentine and 
sweet oil, half and half, containing 2 grains of iodoform to each 
ounce. This mixture may also be used in bronchial catarrh to lessen 
the cough and fetid discharge. 

In fissure of the anus 5 grains of iodoform in the form of a sup- 
pository may be placed in the rectum, and then, after it has remained 
there a few minutes, defecation may be had without pain. 

Administration. — The ointment ( Unguentum lodoformi, U. S. and 
B. P.) is useful when applied over fetid sores. The drug itself may 
be given in 1 to 5-grain doses three times a day. The suppositories 
(Suppositoria lodoformi) are officinal in the B. P. ; each one contains 
3 grains of iodoform. 



IODOL. 

This is a dark, dirty yellowish-looking powder, soluble in alcohol, 
ether, and oils, but only slightly so in water. Its uses in medicine 
are identical with those of iodoform, but it possesses the advantage 
of being far more odorless. 

In tubercular laryngitis the powder may be blown into the larynx 
without disagreeable results and with a favorable effect on the dis- 
eased process. Cerna has found it of very great service in diabetes 
when given internally, in the dose of from 2 to 6 grains three times 
a day. 

IPECACUANHA. 

Ipecacuanha, 11 S. and B. P., or ipecac of medicine is the root of 
Cephcdis Ipecacuanha a small shrub of Brazil. It contains an alka- 
loid, emetine and ipecacuanhic acid. 

Physiological Action. — Locally applied to mucous membranes 
ipecac acts as an irritant, and if applied long to the skin causes vesi- 
cles and irritation. Very minute doses have little noticeable effect, 
but large ones produce nausea, relaxation, vomiting, free secretion 
into the bronchial tubes, and a profuse now of saliva. The emesis 
is due to the irritation of the stomach and to an effect upon the 
vomiting centre in the medulla. 



IPECACUANHA. 191 

If emetine is given in lethal dose death is due to failure of respira- 
tion. 

Therapeutics. — Ipecac is used as an emetic where a fairly rapid 
action is required. It is particularly useful in cases where the 
stomach of a child is overloaded with food. In poisoning it is 
hardly active or rapid enough as an emetic and is not so good as 
mustard or sulphate of copper. In babies and young children an 
attack of bronchitis often causes digestive disorders, by reason of the 
mucus coughed up from the lung being at once swallowed instead of 
spit out of the mouth. In these cases the stomach may be relieved 
and the state of the lungs improved by the use of an emetic dose 
of syrup of ipecac. (Dose, 2 to 3 drachms.) 

In obstinate vomiting small doses will act as a most successful cure, 
provided that the vomiting is due not to inflammation and excitement, 
but to depression. The irritant effect of the ipecac stimulates the 
depressed organ up to a normal tone. 

In some cases of the vomiting of pregnancy it is very useful, in 
others it utterly fails. One drop of the wine or one or two grains of 
the powdered ipecac is all that should be used. In vomiting, with 
flatulence, either ipecac or mix vomica are of service. In the morn- 
ing vomiting of drunkards ipecac is of service, but is not so good as 
small amounts of arsenic or hydrochloric acid. 

In acute, true dysentery ipecac is the best remedy we possess. 
When the passages are large and bilious and the disease is malignant, 
as it occurs in the tropics, ipecac should be given in the following 
manner : The powdered ipecac should be given in the dose of 60 
grains at once to produce vomiting. After vomiting has taken place 
small doses of 3 grains are to be given every hour and continued 
until a profuse black stool is passed. The passage of this stool is a 
most favorable prognostic sign, and its non-appearance is equally 
significant of harm. 

In choleraic diarrhoeas and cholera morbus ipecac is often of great 
service in the dose of 3 grains every two hours. No less a person 
than the great Trousseau asserted that ipecac was a haemostatic, and 
it is said to be most effective in haemoptysis in small doses. 

As an expectorant ipecac is to be used in the early stages of bron- 
chitis, to act as a sedative to the inflamed mucous membrane and 
promote secretion. Under these circumstances it is best combined 
with citrate of potassium (see Bronchitis). Ringer and Murrell have 
fouud that inhaling ipecac spray is very useful in chronic icinter cough 
or bronchitis, particularly when there is shortness of breath present. 

The pure wine may be used in a spray apparatus, or be diluted 
one-half with water. While the throat may seem temporarily worse 
the shortness of breath rapidly decreases, aud a great improvement 
takes place in the cough. In order that the wine which collects in 
the mouth be not swallowed, the patient should be directed to rinse 
the mouth thoroughly every few minutes lest nausea and vomiting 



192 DRUGS. 

result. The inhalation should not last at first over three or four 
minutes, and until it is known how well the patient will bear the 
application, the wine should be diluted twice or thrice. 

Administration. — The syrup (8yrupus Ipecacuanha, TJ. 8.) is given 
in the dose of \ to 1 drachm as an expectorant, or in the same dose as 
an emetic to an infant. The wine [Vinum Ipecacuanha, TJ. 8. and 
B. P.) is given in the same dose as the syrup, the fluid extract {Ex- 
tr actum Ipecacuanha Fluidum, TJ. 8.) in the dose of 30 drops as an 
emetic to an adult, and, finally, the troches (Trochisci Ipecacuanha, 
TJ. 8. and B. P., \ of a grain each, and Trochisci Morphina et 
Ipecacuanha, TJ. 8. and B. P., ^ of a grain of morphine and y 1 ^- of 
a grain of ipecac), which are used in sore throat, dissolved in the 
mouth. Dover's powder (Pulvis Ipecacuanha et Opii, TJ. 8.) is given 
in the dose of 5 to 15 grains. 

Emetine may be given in the dose of y 1 ^- to -^ grain as an emetic. 

Compound ipecac powder (Pulvis Ipecacuanha Compositus, B. P) 
is given in the dose of 5 to 14 grains, and the pill of ipecac and 
squill (Pilula Ipecacuanha cum Scilla, B. P.), in the dose of 5 to 10 
grains. 



JABORANDL 

Pilocarpus, TJ. 8., Jaborandi, B. P., is derived from the South 
American tree, Pilocarpus Pennatifolius. It contains two alkaloids 
known as pilocarpine and jaborine, a volatile oil, and other minor 
constituents. 

Physiological Action — When jaborandi is taken by the healthy 
man in medicinal dose it causes a deep flushing of the face aud neck, 
followed by the outbreak of a profuse sweat, which, though begin- 
ning in these regions, rapidly spreads over the entire body. Accom- 
panying the sweat the salivation is often exceedingly profuse, so that 
saliva dribbles from the mouth. Nausea frequently comes on and the 
severe vomiting may appear in susceptible persons either during or 
after the sweating. On the contrary, some individuals are singularly 
insusceptible, and this is particularly so with children, according to 
Ringer, who will often take as much as 60 grains of the crude drug 
before they perspire. Some adults also refuse to yield to its influ- 
ence. 1 The sweat lasts from three to five hours. 

Nervous System. — Moderate doses have no effect on this part of 
the body, but poisonous amounts cause in the frog tetanic reflex con- 
vulsions, and finally paralysis, the latter being due to depression of 
the muscles and spinal centres. The nerves escape. 

1 The writer has reported a case (see Idiosyncrasy, page 25) where a woman of thirty 
received three-quarters of a grain of the muriate of pilocarpine hypodermically in half 
an hour without any effect. 



JABORANDI. 193 

Circulation. — In large doses there is no doubt that jaborandi 
acts as a cardiac depressant rather than a stimulant, and while there 
may be no evidence of an experimental character pointing to such a 
conclusion, it will be found to be so in practical medicine. The drug 
causes, in the lower animals, a slow pulse and increased arterial pres- 
sure in moderate quantities, the first change being due to an action on 
the inhibitory centres in the heart or the peripheral vagi. Ringer, 
on the other hand, has proved that it slows the beat of the ventricles 
in the frog, which are separated from these centres, and believes that 
the drug acts directly on the motor centres of the heart-muscle and 
the muscle itself. In man the drug does not slow the pulse but 
quickens it very markedly, often as much as forty to fifty beats per 
minute. The rise of arterial pressure seen in animals is often replaced 
by a fall of pressure in man, and though the pulse in animals is often 
stronger from its use, in man it is generally weaker. 

Temperature. — Jaborandi lowers bodily temperature to a con- 
siderable degree, probably by the dilatation of the peripheral capil- 
laries and the profuse sweat which it produces. This fall is some- 
times preceded by a brief rise. 

Kidneys and Tissue-waste. — Upon the kidneys jaborandi 
acts very slightly or very strongly, according to its dose. Large 
doses, which produce a profuse sweat, naturally decrease the urinary 
secretion, and small ones undoubtedly increase it. Upon the tissue- 
changes in the body no researches have been made, but it is an un- 
doubted fact that the excretion of urea is largely increased in disease 
under its influence. 

Eye. — Jaborandi contracts the pupil by acting peripherally on the 
nerves of the iris. 

Sweat. — The amount of sweat caused by the drug in man may 
equal as much as a pint, and it is generally, first acid, from the se- 
cretions of the sebaceous glands ; then neutral ; and finally, alkaline. 
The sweating is not due to vaso-motor palsy, but to stimulation of 
the sweat-glands themselves, and the ends of the nerves supplying 
the same. Sometimes excessive salivary secretion supplants that of 
the skin. 

Other Secretions. — Pilocarpine increases the gastric, salivary, 
and lachrymal secretions as well as that of the skin and kidneys. It 
also seems to have considerable influence over the secretion of milk. 

Therapeutics. — Jaborandi or, better still, its alkaloid, pilocarpine, 
is of great value to relieve dropsy of the renal type. In that due 
to cardiac disease it is generally too depressing, and the author 
knows of a case in which a fatal result followed its use under these 
circumstances. It may be used to abort an attack or paroxysm of 
malarial fever, but because of its depressant influence should never be 
employed in asthenic fevers, such as typhoid fever. In pleurisy with 
effusion it may be used, but more efficient remedies are elaterium or 
salines given at the proper time of the day. (See Magnesium Sul- 

13 



194 DRUGS. 

phate.) In urcemic poisoning pilocarpine is the most efficient and 
rapidly acting remedy that we have, and when used in Brighfs Dis- 
ease is of value in several ways; first, by removing the strain on the 
kidneys ; second, by eliminating the ursemic poison ; and third, by 
lowering the inflammatory action of the kidneys if they are acutely 
inflamed. The drug in small doses certainly increases renal activity. 
The dose should be about ■£$ of a grain hypodermically as a renal 
stimulant. In some forms of profuse sweating, such as come on at 
night in general debility, pilocarpine, if given hypodermically about 
two hours before the sweat in the dose of -£-§ of a grain, is often useful, 
even where atropine fails. Pilocarpine certainly has a decided effect 
in encouraging the growth of hair, and applied locally will often do 
good in partial baldness. If too much pilocarpine is used it is apt 
to cause the development of small pustules about the hair follicles. 
Bartholow recommends the following application for baldness : — 

R. — Extract, pilocarpi ....... f %}. 

Tincturse cantharidis . . . . . . f t |ss. 

Linimentum saponis . . ... . f Jjjss. 

Antagonisms of Jaborandi. — Jaborandi is a physiological anti- 
dote to atropine, and to agaricin, four times as much pilocarpine 
must be used to equal a dose of atropine. 

Administration. — The dose of jaborandi is 40 grains, used in the 
form of the powdered leaves in infusion. The fluid extract (Ex- 
tractum Pilocarpi Fluidum U. S.) should be used in 30 drops to 1 
drachm doses. Pilocarpine is far superior to jaborandi, in that it 
does not so often produce nausea and vomiting. It is used in the 
form of the hydrochlorate (Pilocarpine Hydrochloras U. S.) in the 
dose of from J to J of a grain hypodermically or J to J of a grain 
by the mouth. 

The preparations of the B. P. are, the extract (Extrachim Jabo- 
randi), dose 2 to 10 grains; the infusion (Infusum Jaborandi), dose 
1 to 2 fluidounces; the tincture (Tinctuva Jaborandi), dose \ to 1 
fluidounce; and the nitrate (Pilocarpines Nitras), dose -^ to J grain. 

Clinical reports show that pilocarpine in small doses is a very 
good remedy in tobacco and alcoholic amblyopia, and Da Costa has 
recently highly recommended the hypodermic injection of pilocar- 
pine around the border line of erysipelatous inflammations as a cura- 
tive and preventive measure in the early stages. 



JALAP. 

Jalap (Jalapa, U. S. and B. P.) is the root of Exogonium Purga, is 
a native of Mexico. It contains two resins, Jalapin and Convolvulin, 
neither of which is used in medicine. In overdose it causes vom- 
iting and purging, with gastro-enteritis. 



JUNIPER. 195 

Therapeutics. — Jalap is used in medicine as a hydragogue purge 
to relieve dropsies of any origin. It may be used to deplete in cases 
of general plethora with cerebral congestion, and owing to its taste- 
lessness, is a useful cathartic in children if given in the proper dose, 
namely, 1 to 2 grains in half an ounce of syrup of rhubarb. Com- 
bined with calomel it is preferred to all other purges by some practi- 
tioners, particularly if the liver is torpid. 

Administration. — Jalap may be given in powder (Pulvis Jalapas 
Compositus, U. 8. and B. P.), dose 15 to 40 grains ; in the abstract (J.6- 
stractum Jalapos, TJ. $.), dose 5 to 15 grains ; and the resin (Besina 
Jalapce, TJ. 8. and B. P.), dose to an adult, 2 to 4 grains. Owing 
to the small size of the close of the resin and its lack of taste, this 
is to be preferred for children in the dose of \ to J a grain The 
tincture (Tinctura Jalapce, B. P.) is given in the dose of J to 2 
fluidrachms ; the extract [Extractum Jalapce, B. P.) is used in the 
dose of 5 to 15 grains. 

JUNIPER. 

Juniperus, TJ. 8., is the fruit or berry of Juniperus Communis, an 
evergreen of Northern Europe and America. It contains a volatile 
oil and an amorphous principle, juniperin. 

Physiological Action. — Juniper acts as a gastric stimulant and 
tonic, as a mild diaphoretic if combined with alcohol, and as a 
marked stimulating, exciting diuretic. It escapes from the body by 
the kidneys. 

Therapeutics. — Juniper is valuable as a stimulant to the genito- 
urinary system wherever it is depressed or chronically diseased, as 
in chronic pyelitis, nephritis, and chronic catarrh of the bladder. In 
congestion of the kidneys, if not accompanied by active renal changes, 
it relieves these organs and does away with albuminuria. Used after 
an attack of acute Brighfs disease when reaction has set in and the 
secreting epithelium of the kidney is atonic it is of value, but care 
should be taken that all inflammation has passed by or it will make 
matters worse. In the later stages of scarlet fever in which the renal 
condition corresponds to that just described, juniper is useful. In 
old persons a sensation of weight across the lumbar region is often 
readily removed by the use of juniper if the kidneys are inactive. 
. Administration. — Juniper is .used in the form of the compound 
spirit (Spiritus Juniperi Compositus, TJ. 8.), composed of the oils of 
juniper, caraway, and fennel, combined with alcohol and water, in 
the dose of 1 to 4 drachms. Gin is virtually identical with the com- 
pound spirit. The infusion of juniper is made by adding an ounce 
of the berries to a pint of boiling water and allowing it to stand in 
a warm place for an hour. The entire quantity is to be taken in 
twenty-four hours and is often combined with acetate of potassium 



196 DRUGS. 

or an ounce of the bitartrate of potassium in the treatment of dropsy. 
The spirit (8piritus Juniper i, U. 8. and B. P.) is given in the dose 
of 30 minims to 1 drachm. The oil (Oleum Juniperi, U. 8. and 
B. P.) is used in the dose of 1 to 4 minims. 



KAMALA. 

Kamala, U. 8. and B. P., or Rottlera, as it is sometimes called, is 
the hairs and bristles from the capsules of Rottlera Tinctoria, a plaut 
of Abyssinia, India, and China. It contains au active principle, 
rottlerin, which is not officinal. Given in the dose of 1 to 2 drachms 
it acts as a drastic and as a remedy for tapeworm. It should be 
administered in syrup, and repeated in eight hours if no effect is 
produced. (See Worms.) 

KINO. 

Kino is the inspissated juice of the Plerocarpus Marsupium, a 
tall tree of India. It contains kino-tannic acid and is used as an 
astringent in serous diarrhoeas. It is officinal in the form of the 
tincture (Tinctura Kino, U. S. and B. P.) given in the dose of 1 
fluidrachm. It may be used as a gargle in sore throat and relaxed 
uvula. Under the name of compound powder of kino (Pulcis Kino 
Qompositus, B. P.) an efficient and pleasant anti-diarrhoea powder 
may be used. This powder is not officinal in the U. 8. P. The 
formula consists of 15 grains of powdered kino, 4 of powdered cin- 
namon, and 1 of powdered opium in each powder. 



KRAMERIA. 

Krameria, U. 8., Kramerice Radix, B. P., is sometimes called 
Rhatany, is the root of Krameria Triandra and Tomentosa, shrubs of 
Peru and New Granada, and is employed in serous diarrhoeas with 
good effect, The tincture (Tinctura Kramerice, U. 8. and B. P.) is 
£iven in the dose of 1 drachm, the solid extract (Extractum Kramer - 
ice, U. 8. and B. P.) 5 to 10 grains, the fluid extract (Extractum 
Kramerice Fluidum, TJ. 8.) dose 10 to 20 drops, and the syrup 
(Syrupus Kramerioe, U. 8.) dose 1 ounce. The troches (Trochisci 
Kramerice, U. 8.) are held in the mouth for a local astringent effect. 
An infusion (Infusum Kramerice) is officinalj in the B. P., dose 1 to 
2 ounces. 



LEAD. 197 



LANOLIN. 



Lanolin is a fat derived from the wool of the ordinary sheep and 
is supposed to possess very; remarkable penetrating powers as an 
application to the skin in cases where much infiltration is present, 
particularly if combined with resorcin or some similar medicament. 
In itself it has little curative power, and is no better than lard, oil, 
or any common fat. In some cases, which are rare, it will cause 
irritation of the skin. 



LEAD. 

Plumbum or Lead is a metal possessing more or less power over 
the organism according to the salts employed. It is not officinal as 
lead itself. 

Physiological Action. — Lead in one of its soluble salts, if applied to 
a mucous membrane, produces a bleaching which is particularly notice- 
able where the redness of inflammation has previously existed. It 
has little effect in single dose except by an indirect influence over the 
circulation, nervous system, or respiration. For the effects of over- 
doses see Poisoning by Lead, below. 

The most irritant and poisonous salt is the nitrate, the next the 
subacetate, and the least poisonous of the soluble salts is the acetate. 

Acute Poisoning. — When the acetate of lead is taken in poisonous 
amount it produces a sweet metallic taste in the mouth followed by 
pain in the epigastrium and the vomiting of white, milky-looking 
liquids or white curds mixed with food. The white color is due to 
the chloride of lead formed by the action of the gastric juice. 

The pain continually increases, and diarrhoea due to gastro-enteritis 
may be set up, or, in other cases, obstinate constipation is present. 
The passages are generally black, this being due to the presence of 
the sulphide of lead. At the same time the pulse becomes rapid, 
tense, and cord-like, and after a time weak and relaxed. The face is 
anxious and pale, or livid. The thirst is excessive and cramps in 
the calves of the legs or muscular twitchings may ensue. It is said 
that the blue line on the gums may appear in acute poisoning, but 
this is not based on fact. If coma comes on, death is assured. 

The treatment consists in the use of the chemical antidote, a 
soluble sulphate, in large quantity, and in the administration of 
emetics and the use of the stomach-pump if the vomiting produced 
by the drug is not sufficient to rid the stomach of all the poison. 
The best soluble sulphates to employ are Epsom and Glauber salts, 
because they are always at hand, are readily soluble, and, in excess, 
act as purges, which will wash out the intestinal canal. Hot appli- 



198 DRUGS. 

cations should be applied and the pain and irritation relieved by 
opium. 

Chronic Poisoning. — Chronic lead-poisoning is rarely produced by 
the soluble salts of lead, nearly always it is due to the insoluble salts. 
The symptoms of chronic lead-poisoning or plumbism are as various 
as it is possible to find variety in the signs of disease of every kind. 
There is no train of symptoms which may not occur, and the occur- 
rence of rare, anomalous symptoms in a given case should at once 
bring to the mind the thought of lead-poisoning or syphilis. Chronic 
poisoning occurs in painters, manufacturers of lead salts, and every 
one who is largely thrown in contact with the metal. It is seen 
from the use of hair-dyes containing the acetate of lead, from drink- 
ing-water which has passed through new lead pipe, and even from 
the biting of threads loaded with lead to increase the weight. Chro- 
mate of lead has been used to color sponge cake, when eggs were 
thought too dear, and has killed many persons. Millers, who have 
filled the holes in grindstones with lead, have caused widespread 
epidemics, of what has been called " dry cholera," and many persons 
have suffered from lead- poisoning on eating apple-butter kept in jars 
glazed with lead. 

The most prominent, but by no means the most constant symptom 
of chronic plumbism, is bilateral wrist-drop, due to palsy of the 
extensor muscles of the forearm. The short extensor of the thumb 
generally escapes the drug's influence. Sometimes internal squint 
arises from paralysis of the external rectus muscles. Another very 
common symptom is colic centering around the umbilicus and ra- 
diating through the belly and loins. Obstinate constipation often 
accompanies these symptoms, and the fseces, when passed, are white 
and clay colored. 

During the attack of colic the arterial tension is increased very 
markedly, the tongue is coated and whitish, and the appetite is lost. 

If these early warnings are disregarded and the exposure is con- 
tinued, cerebral symptoms come on, known as encephalopathy sat- 
urnina or saturnine cerebritis. Saturnine epilepsy is not very rare. 
If convulsions come on death generally ensues. The convulsions in 
some cases are not due to a cerebral effect of the lead, but to uraemia 
from the renal changes present. 

Renal disease is very commonly produced by lead, and it is not 
uncommon for chronic contracted kidney to be found at the autopsy. 
If a patient with chronic lead-poisoning have a urine with a per- 
sistent low specific gravity, the prognosis is grave as evidencing 
advanced kidney involvement. 

Asthma, due to inhalation of lead-dust, is sometimes seen. 

The most important confirmatory evidence of chronic lead-poisoning 
is a blue line on the gums just where they join the teeth. Its absence is 
not a negative sign, however, as persons cleanly in respect to their 



ACETATE OF LEAD. 199 

mouths often do not have it. Marked cachexia or anaemia is com- 
monly seen. 

After prolonged poisoning the nerve-trunks are found atrophied 
and finally changed into fibrous cords. Poliomyelitis, anterior or 
posterior, may be present, and locomotor ataxia is commonly caused. 
It is said that the locomotor ataxia of lead may be distinguished 
from the idiopathic form by the fact that in lead-poisoning the sphinc- 
ters are affected while they escape in the non-toxic form. 

In some cases trophic changes in the joints ensue, and plumbic 
gout is not rarely seen or even lead arthralgia with deposits in the 
joints. 

Lead escapes from the body in the urine, the faeces, and all the 
secretions. It is chiefly eliminated by the liver and the bile. 

Treatment of Chronic Poisoning. — The treatment consists in 
three classes of measures : 1st, the removal of the cause ; 2d, the 
removal of the poison in the body ; and, 3d, the treatment of the 
lesions produced.. 

In lead-colic hepatic purges, such as jalap and calomel, combined 
with opium to prevent pain, are indicated, and alum and opium, or 
morphine, are said to be almost specifics, the alum in two-grain doses ; 
the others in full amounts. 

In the cerebral inflammation of lead poisoning a blister to the back 
of the neck, revulsives, and a pilocarpine sweat may be resorted to. 

To aid in the elimination of the lead iodide of potassium, which 
forms double soluble salts in the tissues with the drug, is to be used, 
10 grains three times a day. 

If progressive paralysis is present Wood insists on the use of 
large doses of strychnine at the same time that the iodide is given. 
The strychnine should not, of course, be given with the iodide, as it 
is incompatible. 

Electricity should be used as a remedy to restore lost function. 
If the faradic current makes the muscles contract it should be em- 
ployed, and, if not, the galvanic should be used. Curiously enough 
voluntary power sometimes returns before the muscles will react at 
all to electricity. 

It is said that baths of sulphurets of potassium should be used ; 
5 or 6 ounces of the salt to each bath, which is to be given in a 
wooden tub. The patient should afterward be well soaped, then 
well rinsed off, and rubbed down with a rough towel. 

As each salt of lead is used for different purposes the therapeutics 
of each one will be taken up separately. 



Acetate of Lead. 

Acetate of Lead (Plumbi Acetas, U. S. and B. P.), or sugar of 
lead, has a sweet, astringent taste, and is soluble in water, although 



200 DRUGS. 

the solution is slightly milky. The B. P. recognizes the following 
preparations of lead acetate (Pilula Plumbi cum Opio), dose 3 to 5 
grains; Suppositoria Plumbi Composita, each suppository containing 
1 grain of opium to 3 grains of lead acetate ; and an ointment 
( Unguentum Plumbi Acetatis). 

Therapeutics. — Acetate of lead may be used, and is largely em- 
ployed in the following pill in serous diarrhoea: — 

R. — Plumbi acetat gr. xl. 

Pulv. opii . . . . . . . . gr. x. 

Camphorse . . . . ' . . . . gr. xl. 

M. ft. in every pill JSTo. xx. — S. One every four hours. 

This pill may be given in dysentery. 



Liquor Plumbi Subacetatis. 

Liquor Plumbi Subacetatis, U. S. and B. P., or Goulard's extract' 
is a colorless liquid, much used externally, when diluted, with lauda- 
num, for sprains, bruises, and local inflammations, under the name 
of lead water and laudanum. The proportion should be 7 parts ot 
the lead water, diluted with 14 parts of water, to 1 of laudanum, but 
this is varied as the inflammation or pain is more severe. The offi- 
cinal liquor is also officinal in a dilute solution (Liquor Plumbi Sub- 
acetatis Dilutus, U. S. and B. P.), and, as such, is too weak for ordinary 
use, although it is commonly employed. The strong solution should 
be used in the strength of from 1 to 4 ounces to the pint of water. 
This solution should never be employed if the skin is broken, as ab- 
sorption may occur, and what is more important still it prevents, 
healing by constringing and whitening the edges of the wound. If 
some bread crumbs be saturated with this solution and applied to a 
finger it will abort a felon in the early stages. The officinal dilute 
solution is useful as a lotion in eczema, which itches and tingles, and 
is not dry. It should be applied once or twice a day, and it is well 
to follow it with a weak sulphur bath or alkaline wash. (See Eczema.) 

This solution is also useful in pruritus pudendi, and the acetate of 
lead may be used as an injection in the dose of 1 to 8 grains to the 
ounce in gonorrhoea. The cerate ( Ceratum Plumbi Subacetatis, U. S.), 
the liniment (Linimentum Plumbi Subacetatis, U. S.), and the glycerin 
(Glycerinum Plumbi Subacetatis, B. P.), may be used for the same 
purposes as the Goulard's extract. 



Carbonate of Lead. 

Carbonate of Lead (Plumbi Carbonas, U. S. and B. P.) is insoluble, 
and is used as a coating or dressing for burns, scalds, or ulcers, when 



LIPANIN. 201 

rubbed up with linseed or other oil, or in the form of the ointment 
( Unguentnm Plumbi Carbonatis, U. S. and B. P.). If a wide sur- 
face is exposed it may cause poisoning by absorption. 



Nitrate of Lead. 

Nitrate of Lead (Plumbi Nitras, U. S. and B. P.) is never used 
internally but as a powder around onychia maligna, and in Ledoyen's 
Disinfecting Solution. The latter discolors the paint in water- 
closets, and dissolves the solder in drain-pipes, and is not a good 
preparation for general use. 

Litharge. 

Litharge {Plumbi Oxidum, U. S. and B. P.) is used for the prepa- 
ration of lead plaster (Emplastrum Plumbi, U. S. and B. P.), and this 
is in turn employed for the manufacture of resin plaster {Emplastrum 
Hesince, U. S. and B. P.). It is also used in the preparation of the 
solution of subacetate of lead {Liquor Plumbi Subacetatis, U. S. and 
B. P.). 

Hebra recommends for sweating of the feet an application of equal 
parts of lead-plaster and linseed oil, applied on linen, and wrapped 
around the feet every third day. 



Iodide of Lead. 

Iodide of Lead (Plumbum Iodidum, U. S. and B. P.) is occasion- 
ally employed in medicine ; the dose is J to 3 grains. Emplastrum 
Plumbi Ioclidi, B. P., and Unguentum Plumbi Iodidi, U. S. and B. P., 
are useful as external astringent applications. 



LIPANIN. 

Lipanin is an artificially prepared mixture devised by von Mering 
as a substitute for cod-liver oil, and consists in 6 parts of oleic acid 
to each 100 parts of olive oil. The advantages possessed by it are 
its lack of disagreeable odor and taste, and its ready emulsification 
and digestibility. The commencing dose is 1 drachm, and it may 
be increased to 4 drachms. This mixture has been found of value 
in most of the diseases in which cod-liver oil is employed, but in the 
opinion of the author its efficacy is greatly increased if the hypo- 



202 DRUGS. 

phosphites of lime and sodium are used at the same time in the dose 
of 10 grains each three times a day. 



LIQUORIOE. 

Licorice (Glycyrrhiza, TJ. 8. P., Glyeyrrhizm Radix, B. P.) is the 
root of Glycyrrhiza Glabra a plant of Southern Europe and Asia. 
It is used in the form of the solid extract to increase secretion in the 
mouth, and when dissolved in water to form a vehicle for other 
drugs, particularly if they have a disagreeable taste. The powdered 
solid extract is a very mild laxative and forms the bulk of the com- 
pound liquorice powder. 

Administration. — The solid extract (Extractum Glyeyrrhizm TJ. 8. 
and B. P.) is used in a dose anywhere from 5 to 120 grains. The 
pure extract (Extractum Glycyrrhiza^ Purwn, TJ. 8.) is used in the 
same quantities as the ordinary extract. The fluid extract (Ex- 
tractum Glycyrrhiza^ Lluidum, TJ. 8.) or the liquid extract (Extractum 
Glycyrrhizce Liquidum, B. P.) is used in 1 to 2 drachm doses. Under 
the name of Brown mixture or "compound liquorice mixture/' a 
very efficient expectorant mixture is officinal (Mistura Glycyrrhizce 
Comjjosita, TJ. 8.) which contains as its most important ingredients 
12 parts of paregoric, 6 parts of wine of antimony, and 3 parts of 
sweet spirit of nitre. The dose is 1 to 4 drachms. Pulvis Gly- 
cyrrhiza Compositus ( TJ. 8. and B. P.), or compound liquorice powder, 
contains, according to the TJ. 8. P., 18 parts of senna, 16 of liquorice, 
8 of fennel, 8 of washed sulphur, and 50 parts of sugar. According 
to the B. P. it should contain 2 parts of senna, 2 parts of liquorice 
root, 1 part of fennel fruit, 1 part of sublimed sulphur, and sugar 
6 parts. The Troches {Trochisci Glycyrrhizce et Opii, TJ. 8. and 
B. P.) contain -^V grain of opium and 2 grains of extract of licorice. 
Finally we have Glycyrrhizinum Ammoniatum, TJ. 8., which is the 
sweet principle of liquorice rendered soluble and easily tasted by the 
addition of ammonia. The dose is 5 to 15 grains. 



LITHIUM. 

Lithium is used in several forms, but its salts may be divided into 
two classes — those which act as lithium and those which act as the 
acids forming them. In the first class we have the carbonate (Lithii 
Carbonas, TJ. 8. and B. P.) dose 2 to 10 grains, and the citrate 
(Lithii Citras, TJ. 8. and B. P.), dose 5 to 20 grains. In the second 
class we find the benzoate (Lithii Benzoas, TJ. 8.), dose 5 to 30 grains ; 
Lithii Bromidum, TJ. 8., close 10 to 40 grains, and Lithii 8alicylas, 
TJ. 8., dose 10 to 30 grains. 



LOBELIA. 203 

The carbcmate and citrate are used in gout and rheumatoid arthritis 
for the purpose of entering into combination with the uric acid in the 
body to form soluble urates and prevent deposits in the joints. They 
have been said to dissolve calculi, but this is doubtful. They are 
very useful when it is desired to render the urine alkaline. The 
carbonate is not soluble in water and should be given in capsule or 
freshly-made pill, but the citrate is soluble. The latter may be 
made from the former by taking 50 grains of the carbonate, 90 grains 
of crystallized citric acid, and warm distilled water 1 nuidounce. 
The acid should be dissolved first and the carbonate added to the 
solution. The solution should then be kept hot until effervescence 
ceases. 

In cases of diabetes depending upon a gouty taint remarkable 
results are often obtained from the use of the citrate or carbonate of 
lithium and arsenic. The dose should be -fa of a grain of arsenite 
of sodium and 10 grains of the lithium salt three times a day. 

For the use of the other salts see the articles on the bromides, 
salicylic acid and benzoic acid. 

It is worthy of note that in some cases citrate of lithium will 
disorder the stomach and produce vomiting. Lithia water (Liquor 
Lithice Effervescens, B. P.) is useful in gout in quantities of 5 to 10 
ounces at a time. 

LIQUOR POTASS^E3. 

Liquor Potassos, U. S. and B. P., is a solution of potassa contain- 
ing about 5 per cent, of potassium hydrate, and is a clear, odorless 
liquid of caustic taste and strongly alkaline reaction. It is used in 
medicine as an antacid and for the purpose of decreasing acidity of 
the urine. 

In ingrowing toe-nail it is often used to soften the nail, prior to 
packing with cotton or partial evulsion. Its dose is 5 to 30 drops 
well diluted in water. 

LOBELIA. 

Lobelia. U. 8. and B. P., is the leaves and tops of Lobelia Inflata, 
a common weed of the United States. It contains an alkaloid 
Lobeline and Lobelic Acid. 

Physiological Action. — When taken in overdose lobelia causes 
emesis, intense prostration, a feeble pulse, pale skin, livid face, mus- 
cular relaxation and cold sweat. Violent purging may be present. 
It is said to paralyze the motor nerve-trunks, and it causes a fall of 
arterial pressure, followed by a rise due to the asphyxia which it 
finally produces. Ultimately it paralyzes the respiratory centre and 
the peripheral vagi. The treatment of the poisoning is to admin- 



204 DRUGS. 

ister opium to stop irritation and vomiting, alcohol and ammonia to 
support the heart, and the use of external heat. 

Therapeutics. — Lobelia is used chiefly as an anti-asthmatic avid has 
been equally highly praised and condemned* by eminent authorities. 
The reason for this lies in the fact that it is generally useless in asthma 
unless given in almost poisonous dose. Wood teaches that it should 
rarely if ever be used because of its poisonous effects in medicinally 
active doses, while Sidney Ringer says it is erroneously thought to be 
dangerous. In asthma both of the gastric and bronchial form it is 
undoubtedly of service. In some cases it certainly fails as signally 
as it ever succeeds. If the asthma is due to or associated with cardiac 
disease it should never be employed. The drug should be taken in 
the dose of \ a drachm to 1 drachm of the tincture at the first sign of 
an attack, or in 10 drop doses every 15 minutes until distinct nausea 
occurs, or relief is obtained. 

In atonic constipation 10 drops of the tincture at bed-time are often 
of service. 

Administration. — Lobelia is given in the form of the tincture 
{Tinctura Lobelice, U. S.), in the dose of 30 drops to 2 drachms, 
according to the severity of action required. The vinegar (Acetum 
Lobelice, U. S.) t in the dose of 20 to 30 drops, and the fluid extract 
(Extractum Lobelice Lluidum, U. '$.), in the dose of 1 to 5 drops, 
and as an emetic in the dose of 15 drops. 

In the form of the infusion, lobelia is useful as a lotion in poisoning 
by poison-ivy. The strength should be an ounce to the pint. 

The preparations of the B. P. are, the Tinctura Lobelice, dose 10 
minims to J drachm, and Tinctura Lobelice JEtherea, dose 10 to 30 
minims. 



LYOOPODIUM. 

Lycopodium, U. S., is a pale yellow powder derived from Lyco- 
podium Clavatum, a species of moss. It is used by pharmacists as a 
powder in which to roll pills, and by physicians and nurses to pre- 
vent the intertrigo or chapping of the skin of infants and adults. 



MAGNESIUM. 

Magnesium is a metal never used as such but always as one of its 
salts, which are the sulphate, citrate, carbonate and sulphite. The 
sulphate is a natural salt found in sea-water and in caves or in the 
water leaving these places. The others are derived from the sulphate. 
The carbonate is insoluble in water and alcohol. The others are 
soluble. 



MAGNESIUM SULPHATE. 205 

Therapeutics. — The carbonate is officinal in the form of the heavy 
and light powder [Magnesia Ponderosa, U. 8. and B. P.), and {Mag- 
nesia, U. S., Magnesia Levis, B. P.). These two substances do not 
differ in respect to their effects. The light magnesium is never given 
internally because of its bulk, but it is used as a dusting powder in 
intertrigo, and in the form of white cubes rubbed on the skin to pre- 
vent excessive perspiration and as a cosmetic. The heavy magne- 
sium is used as an antacid and is not in any sense a laxative, as it 
possesses no such power. When the stomach or intestiues contain 
much acid from fermentative changes these acids may, however, 
unite with the magnesium and form a slightly laxative salt. 

In sick headaches due to great gastric acidity it is often of service. 
The dose of the carbonate is from 5 to 60 grains. It should not be 
used constantly as it will accumulate in the intestines. 

The troches (Trochisci Magnesice, U. 8.) each contain 3 grains of 
light magnesium. 



Magnesium Sulphate. 

Sulphate of magnesium (Magnesii Sulphas, U. 8. and B. P) is a 
white granular powder of neutral reaction, salty taste and is soluble 
in water. It is the form generally known by the laity as " salts " 
although in some parts this also includes the sulphate of sodium. Ac- 
cording to the studies of Hay, and others, sulphate of magnesium is 
a purge by reason of its abstraction of water from the intestinal 
bloodvessels. All strong saline solutions above the strength of 7 
per thousand abstract liquids from the tissues when brought in con- 
tact with them. On the other hand, if a saline solution be less strong 
than 7 per thousand it will abstract salts from the tissues and replace 
them with water. The recollection of these facts readily makes clear 
the use of magnesium sulphate. Whenever a thorough purgative 
action is required, that is, where depletion of the intestine or absorp- 
tion of exudations is to be attained, the magnesium should be given 
in concentrated form, so as to make its solution of as high a per- 
centage as possible. 

In cases of dropsy this is particularly necessary, and from one to 
two ounces should be given before breakfast or on an empty stomach 
in as little water as will dissolve the salt, (See Dropsy.) 

In enteritis and peritonitis this use of magnesium is widely recog- 
nized. The sulphate is not irritating and may be given freely where 
inflammation exists. (See Peritonitis.) It forms a large part of 
most purgative waters. The B. P. recognizes an enema, Enema 
Magnesii Sulphatis, composed of sulphate of magnesium 1 part, olive 
oil 1, and starch mucilage 15. 



206 DEUGS. 



Magnesium Citrate. 

The citrate of magnesium (Magnesium Citras) is a much more irri- 
tating purge than the sulphate but is more agreeable to the taste. It 
is officinal in two forms, one of which is the solution (Liquor Mag- 
nesii Citratis, U. S. and B. P.), which is effervescent and should never 
be used unless freshly prepared. It is made by adding bicarbonate 
of potassium to a syrupy solution of the citrate of magnesium, con- 
taining an excess of acid, and corking the bottle tightly, the cork 
being tied down with a strong cord; the bottle must be strong. The 
dose is half to one pint. It is too irritating to be used where inflam- 
mation of the alimentary canal exists, but is useful in sick and 
bilious headache. 

The granulated citrate (Magnesii Citras Granulatus, U. S.) is 
solid and is less agreeable to take. It should be dissolved in water, 
about 1 to 3 drachms being used in each dose, and swallowed while 
effervescing. It must be kept in bottles tightly corked. Magnesium 
is an antidote to arsenic in itself, and when employed to precipitate 
a soluble preparation of iron it forms the antidotum arsenici (Ferrum 
Oxidum Hydratum cum Magnesia, U. S.). Liquor Magnesii Car- 
bonatis, B. P., is given in the dose of 1 to 2 ounces as a laxative. 
Liquor Magnesii Citratis, B. P., is given in the dose, of 5 to ]0 
ounces. 

MANGANESE. 

Manganum or Manganese is officinal in the form of the black 
oxide (Mangani Oxidum Nigrum, U. 8. and B. P.), and the sulphate 
(Mangani Sulphas, U. 8.). The first of these, under the name bin- 
oxide of manganese, has been highly praised in amenorrhoea de- 
pendent upon functional disturbance and anaemia. The dose is 3 to 
5 grains three times a day, in pill form. The sulphate is rarely if 
ever employed, but may be tried in malarial jaundice. The dose is 
1 to 2 grains. 

MANNA. 

Manna, U. 8. and B. P., is the concrete juice of the exudation of 
Fraxinus Ornus, a tree of Europe. It occurs in small or large 
roundish masses, looking somewhat like a gray -colored gum arabic. 
It has a sweet taste and odor. Sometimes the taste is a little bitter. 

Therapeutics. — Manna is the most feeble of the laxatives, and in 
some persons causes slight flatulence. In children fed by the bottle 
one of the most frequent disorders is obstinate constipation, and for 



MERCURY. 207 

its relief 1 to 2 drachms of manna may be dissolved in the milk of 
each bottle. When given to older children or adults it is always 
combined with other more powerful drugs, chiefly to cover their 
taste. It may be combined with advantage with rhubarb and senna 
and enters into the officinal Infusum Sennce Composition, U. 8. 



MATRICARIA. 

Matricaria, U. S., German Chamomile, consists in the flower heads 
of Matricaria Chamomitta, a European plant, possessing mild tonic 
properties in moderate dose. In larger amounts it acts as an emetic 
and anthelmintic. In the form of an infusion, of the strength of 
1 to 2 ounces to the pint, it has been largely used as a diaphoretic 
and to prevent cotic in teething children. 



MERCURY. 

Hydrargyrum, U. S. and B. P., Mercury, or Quick Silver, is a 
heavy fluid metal of a peculiar color and appearance. As mercury 
it is used in medicine in the form of the ointment, the plaster, gray 
powder, and blue mass. 

Physiological Action. — When mercury is taken into the body in 
one of its soluble and mild preparations, it may cause no evidence of 
its presence until by frequent dosage the system in general begins to 
feel its influence. The first evidences of this are seen in the mouth, 
and consist in tenderness of the teeth when the jaws are firmly and 
quickly closed, foetid breath, sponginess of the gums, which finally 
may bleed at the slightest touch, swelling of the tongue, and, most 
prominent of all, excessive salivation, a condition sometimes called 
ptyalism. If the use of the drug is persisted in all these symptoms 
grow worse. Eczema, and finally sloughs of the chin and chest 
develop as the result of the constant dribbling of saliva and the direct 
depressing effect of the drug on the tissues. The teeth drop out, the 
maxillary bones undergo necrosis, and amid a general melting down 
and decomposition of the tissues the patient dies. The blood is 
affected and becomes very thin, fluid, and poor in its corpuscular 
elements. These symptoms ensue on the use of mercury in continued 
doses, and rarely follow exposure to the drug in the processes of the 
arts. In the arts, as in the making of looking-glasses, the workmen 
are often affected by various trains of symptoms varying very widely 
in their course. In some cases the nervous system becomes chiefly 
affected. Tremors of all sorts arise, paralysis agitans is developed 
in all its characteristics, and widely different changes and degenera- 



208 DRUGS. 

tions in the spinal cord ensue. Chorea often comes on, and its 
occurrence in an adult should cause inquiry as to any possible expo- 
sure to mercury. In other cases brownish discoloration of the skin, 
resembling Addison's disease, appears. Blindness, deafness, sensory 
disturbances, such as hyperesthesia and anaesthesia, are developed, 
and localized wasting of muscles or group of muscles may assert 
themselves. In other cases still the blood becomes impoverished and 
mercurial cachexia is developed. 

Mercury in all its forms is absorbed and eliminated by the kidneys, 
liver, sweat and saliva. No secretion of the body, even to the semen, 
fails to carry it out of the system, but it is to be remembered that, 
although all these parts are actively engaged in its elimination, the 
drug nevertheless rapidly accumulates in the body. 

The question as to the manner in which the mercury finds entrance 
into the body is one of interest and importance. According to cer- 
tain writers, it is changed into an albuminate and so circulates in the 
blood, and while this is probably true it is not known as a fact. 

Balzer and Klumpke have made a long series of observations 
at the Lourcine Hospital, in Paris, on the rapidity of the elim- 
ination of mercury by the kidneys during a treatment of long 
standing. It is generally supposed that the bichloride is held in 
solution as an albuminate of the oxide of mercury united with so- 
dium chloride, but others have asserted that metallic mercury in a 
state of minute subdivision circulates in the blood ; this point, how- 
ever, cannot be considered settled, and the drug undoubtedly accumu- 
lates in all the tissues, more especially in the liver and kidneys. It is 
also well known that it is eliminated by almost all the secretions, 
notably the milk. 

While there are many methods for the estimation of mercury in 
organic fluids, these investigators throughout adopted that of Witz, 
as modified by Souchow and Michaelowsky, which permits of the 
easy detection of a yoVo °^ a g ram m aD ounce. After a single dose 
of mercury the elimination of the drug is rapid and sometimes com- 
plete in twenty-four hours, but if a continuous treatment is inter- 
rupted its excretion continues for some time, and Kussmaul and 
Gorup-Besanez have found it in the liver as much as a year after its 
administration has been stopped. The amount of mercury that can 
be steadily eliminated for many weeks from the. kidneys when the 
body is saturated is about T a g- of a grain a day. 

The practical conclusion to be drawn from these researches is that 
it is well to stop the administration of mercury when the amount 
eliminated by the urine has reached its normal maximum. 

Therapeutics. — The employment of mercury in medicine centres 
around four great points, viz. : 1st, its value in syphilis and kindred 
states ; 2d, its use as a purge ; 3d, its power as an antiseptic and 
germicide; and 4th, its action as an antiphlogistic ; the first and 
fourth points are fulfilled by all the mercury salts more or less per- 



MERCUKY. 209 

fectly, the second only by bine mass and calomel, the third by the 
bichloride and biniodide of mercury. 

In syphilis mercury is to be given not because the patient shows 
symptoms of the secondary or tertiary type of the disease, but because 
the conditions present do or do not call for its employment. Many 
writers have insisted that it ought only to be employed in the sec- 
ondary stages, and while this is as a general rule correct, certain con- 
ditions may call for it at any time. (See Syphilis.) 

The employment of mercury as a purge or laxative having special 
action on the liver is constantly resorted to. The two preparations 
used are bine mass and calomel, but the latter is more active. They 
both cause soft or watery stools according to the dose in which they 
are given, but the blue mass rarely, if ever, is used, except for a lax- 
ative effect. 

Much discussion has arisen as to whether mercury does affect the 
liver, and whether the peculiar greenish or brownish yellow stools 
produced by it are due to the presence of bile or mercury. 

The experiments of Rutherford, Prevost and Binet, and others 
upon the lower animals seem to prove that in these instances, at least, 
mercury does not increase the biliary flow ; but on the other hand it 
is undoubtedly a fact that in man, even so small a dose as -j--^ of a 
grain of calomel, may produce a bilious-looking passage and yet it is 
evident that there cannot be enough mercury present to color a large 
passage green or yellow. Again, analysis of the stools often fails to 
find any mercury unless the doses be large. Further than this we 
know clinically that when the stools are clay-like and lacking in bil- 
iary coloring matter mercury will restore the normal state. The 
conclusion must be reached that, be the results in animals what they 
may, in man, at least, the drug does increase biliary secretion aud 
flow. 

The preparations just named are largely used in the condition 
known as biliousness, and undoubtedly give relief. (See Biliousness.) 
If the tongue is heavily coated, the breath foul, the conjunctiva a little 
icteroid and headache is present, the drug should be employed. In re- 
mittent malarial fever the use of small repeated doses of calomel will 
often bring relief from the vomiting, and this drug should always be 
given in malarial disease before quinine is used, if a thorough action 
of the antiperiodic is required. 

The disinfectant and germicidal power of bichloride of mercury 
and of the biniodide are very well established by clinical experience 
and experimental investigation. The strength of the bichloride in 
solution for antiseptic purposes may vary from 1 to 2,000 to 1 to 
20,000 of water and for disinfectant use from 1 to 500 to 1 to 1000. 
(See Antiseptics.) 

In using the bichloride it is necessary to add a few grains of 
tartaric acid to the solution to prevent its uniting with the albumen 

14 



210 DRUGS. 

of the tissues to form an insoluble and useless albuminate. The 
same is true of the mercury biniodide. 

The antiphlogistic or anti-inflammatory action of mercury is very 
marked indeed, but its employment is absolutely limited under these 
circumstances to one variety of inflammation, namely, the sthenic or 
dynamic form. In inflammation arising during the course of some 
exhausting disease, mercury is not only contra-indicated but harmful, 
thus: If a man in health is stricken with pleurisy or 'peritonitis or 
meningitis or any acute inflammation of a serous membrane be the 
cause what it may, the exudate poured out will probably be fibrinous, 
and capable of undergoing organization, thereby causing adhesions 
of the pleural surfaces, of the intestines or of the meninges of the 
brain. On the other hand, if a man be taken with pleurisy or menin- 
gitis during the course of phthisis or typhoid fever the exudate will 
be serous and large in quantity. 

It is in the first case that mercury should be used to prevent the 
fibrinous exudate or to make it serous. In the second instance it 
will do harm by increasing the exudation. When given as an 
antiphlogistic the drug is often combined with opium to relieve the 
pain and irritation and to prevent purging. In meningitis arising 
from head injuries this treatment is the routine method and may be 
carried out by the use of powders containing J grain of calomel 
and \ grain of powdered opium every hour till 1 or 1J grains of 
each are taken. The simultaneous use of the ice-bag to the head and 
perfect quiet will often bring relief very rapidly. 

Mercury is also the best remedy in sthenic endocarditis and should 
be given in full dose. 

The bichloride may be used in small doses in place of the calomel, 
and does not of course produce the same tendency to laxity of the 
bowels. At the same time it often seems to be less efficacious. 

Mercury in myocarditis and pericarditis is also of service and is 
thought by some to possess distinct prophylactic power in the early 
stages of diphtheria and membranous croup. 

Leaving the general subject of mercury we may now consider each 
individual preparation. 



Blue Mass. 

Blue Mass (Massa Hydrargyria U. S.) (Pilula Hydrargyria B. P.) 
is made by rubbing up metallic mercury with liquorice and other 
excipients and is often called Blue Pill. Each grain of the mass 
contains J grain of mercury and it may be given in the dose of from 
i to 20 grains, for the same laxative purposes that we use calomel. 
Blue Mass is rarely used to produce systemic effects. 



MERCURY WITH CHALK. 211 



Mercury Ointment. 

The ointment of mercury, mercurial ointment (Unguentum Hy- 
drargyria U. 8. and B. P.), sometimes called blue ointment, is made 
by rubbing up mercury with suet and lard until it is extinguished, 
or, in other words, until the globules of mercury cannot be seen with 
a magnifying power of 10 diameters. 

The ointment of mercury is used externally in certain skin affec- 
tions, and for the purpose of influencing the general system in cases 
where the drug cannot well be taken by the mouth. In syphilis 
where a mercurial effect is to be reached, the ointment in small 
amounts should be thoroughly rubbed into the skin in various parts 
of the body, one evening in the left groin, the next in the right 
groin, the next evening in the left axilla and the fourth evening in 
the right axilla, beginning on the fifth evening in the left groin once 
more. This avoids local irritation of the skin, places the drug on 
spots where it is readily absorbed, and very rapidly influences the 
system of the patient. In infantile syphilis this method may be em- 
ployed, or a flannel binder covered with the ointment may be placed 
about the belly. The clothes should not be changed too frequently 
as their saturation aids in producing the impression upon the system, 
and the wearing of an undershirt saturated after a few days' wear 
from the inunctions, is a very valuable though somewhat dirty method 
of producing mercurialization. The ointment of mercury is some- 
times rubbed into the skin over enlarged glands. Under the name of 
the oleate of mercury ( Oleatum Hydrargyria U. S. and B. P.) a very 
efficient and more agreeable application than the ointment is used in 
the same manner. 

In pediculus pubis or in any case where parasites, such as the flea or 
louse, infest the region of the genitals, or any hairy growth, mercurial 
ointment may be used as a cure owing to its lethal influence over 
these troublesome pests. Care should be taken that it does not 
cause salivation of the patient and it must not be allowed to remain 
on the parts but wiped off in the course of an hour or two or less. 
The following words from the pen of Dr. Joseph Leidy are suffi- 
ciently interesting to demand a place at this juncture : " We may here 
say that if it is once understood that all insects, including lice, are 
destroyed quickly by the application of any fixed or volatile oil 
physicians will see there is no necessity of employing remedies of a 
noxious character to the patient. The fat of mercurial ointment is 
probably more quickly active than the mercurial oxide." 

Mercury with Chalk. 

Mercury with chalk (Hydrargyrum cum Greta, U. S. and B. P.) or 
gray powder is slightly purgative but is chiefly employed in the 



212 DRUGS. 

treatment of Infantile syphilis, as it will not freely purge. The dose 
is 1 to 10 grains. In syphilitic marasmus children seem fairly to 
fatten on it. 

Calomel. 

Calomel (Hydrargyri Ohloridum Mite, U. 8. 9 Hydrargyri Subchlor- 
idum, B. P.), or the mild chloride of mercury, is an insoluble salt which 
is nevertheless freely absorbed. Some have taught that it enters into 
the body as a bichloride being so changed in the stomach, but prac- 
tically this does not occur. Calomel on passing into the intestines 
is changed by the alkaline juices there present into the black or gray 
oxide of mercury. 

Calomel when used as a laxative purge should be given in the 
dose of -J- to J of a grain every half hour or every fifteen minutes until 
1 or 2 grains are taken, as it will act as efficiently in this way as if 
10 grains are given at one dose, and there is no danger of producing 
ptyalism. The reason that small doses are as efficient as large ones 
lies in the fact, that only the calomel which is precipitated into the 
gray oxide is active, and as the amount of alkaline juice in the intes- 
tine is small, only a minor part of a large dose of calomel acts, the 
major portion escaping unchanged. This is the reason that bicar- 
bonate of sodium is added to calomel powders, to aid the intestinal 
juice in the reduction of the salt. If purgation does not occur, a 
saline purge should be given at the end of twenty-four hours, and 
this must always be used if large doses are employed. 

Mercury in the form of calomel is very largely used hypodermi- 
cally held in solution by a mucilage, or better still by fluid cosmo- 
line. It should be injected deeply into the tissues, not immediately 
under the skin, the greatest cleanliness being necessary to avoid ab- 
scesses. The best place for these injections is in the fold of the 
buttocks but sloughing, tetanus, and even gangrene, has followed its 
employment in this way. (See Salicylate of Mercury.) 

In dysentery of the acute form calomel and ipecac are the two best 
remedies (See Dysentery and Ipecac). It should be given in small 
doses repeated every hour or half* hour until some effect in the number 
and character of the stools appears. 

In children who seem constantly " under the weather " and never 
quite well, who have flahdence, foetid, breath and ill-smelling , pasty 
stools calomel often gives great relief in the dose of -^ of a grain 
every half hour until four doses are taken, this treatment being pur- 
sued every fourth or fifth morning. 

In jaundice due to exposure to cold and slight hepatic congestion 
^ of a grain of calomel every half hour till J a grain is taken will 
often bring relief. 

Calomel is generally prescribed in conjunction with sugar of milk, 



CALOMEL. 213 

white sugar or bicarbonate of sodium, which are added to increase the 
bulk aud wieldiness of the powder, aud in the case of the latter ingre- 
dient, to increase its activity. Owing to its lack of taste, calomel is 
often placed on the tongue of children, but in this iustauce the white 
sugar is to be used, in small quantity, as the other vehicles are less 
agreeable. 

A very important use of calomel and one which has been brought 
forward very recently as new, but which is many years old, is its em- 
ployment in dropsy as a diuretic either alone or combined with squills 
or digitalis, or opium to prevent purging. The dose should be 
small, about 1 grain thrice a day, and if a diuretic influence does not 
assert itself in twenty-four hours it should be stopped. Still another 
use of calomel is in typhoid fever in which disease it has been highly 
recommended in small repeated doses, particularly if constipation is 
present. In the opinion of the author this is disadvantageous as a 
routine measure and entirely uncalled for. 

Sidney Ringer has called attention to the fact that in constipation 
or in " biliousness " podophyllin does more good than calomel pro- 
vided that the stools are dark in color, whereas if the same sigus are 
present but the stools light and clayey in color calomel is more effi- 
cient. The author has proved the correctness of this assertion so fre- 
quently that he is convinced of its truth. 

Calomel has been recommended in the condition of anorexia and 
depression following acute diseases, and when the tongue is covered 
by a thick yellow coat it is the remedy for the gastro-intestinal torpor 
always present. While purgative doses of calomel certainly are of 
value, the use of dark red freshly prepared nitro-muriatic acid is, 
however, highly preferable in many such instances to the mercurial 
salt. 

Calomel is often given in small doses to u settle the stomach." 
Sometimes it will act in this way, but in other cases it will seem to in- 
crease the nausea and bring on vomiting. This is true of both adults 
aud children, and it is impossible to tell beforehand which will occur. 
In a peculiar form of vomiting occurring in very young children, 
which comes on immediately after the food is swallowed, the rejection 
of milk being forcible and perhaps so sudden that it is not even 
curdled, and which is not accompanied by much straining, calomel 
will often give relief when all other remedies fail. It should not be 
resorted to until some evidences of wasting occur, as this action of the 
stomach in many children only rids it of part of the milk which is 
in excess, and is a purely physiological regurgitation. The calomel 
may be given in the dose of ^ °f a grain every hour, or if preferred 
gray powder in the dose of J of a grain every hour is equally effi- 
cient in these cases. 

Calomel will often remove syphilitic condylomata if dusted over 
them for some time, and an ointment made of one drachm of calomel 
to one ounce of lard is very useful in pruritus. 



214 DRUGS. 



Calomel ointment ( Unguentum Hydrargyri Subchloridi, B. P.) is 
often useful in the treatment of small patches of eczema. 



Bichloride of Mercury. 

The Bichloride of Mercury, or corrosive sublimate {Hydrargyrum 
Ohloridum Oorrosivum, U. S., Hydrargyri Perchloridum, B. P.) as it 
is called, is an exceedingly poisonous aud irritating substance when 
in concentrated form. 

Taken internally it causes violent pain in the stomach, vomiting, 
purging of mucus, blood and the contents of the intestine, collapse, 
syncope, and death. If taken in poisonous amount the patient should 
be made to swallow large amounts of the antidote, white of egg, the 
stomach should be washed out by the stomach-pump, heat should 
be employed about the body, and the proper stimulants be given if 
the pulse or respiration fail. If death does not occur at once the 
patient has a protracted convalescence or else dies from the organic 
changes produced in the gastro-intestinal tract, such as strictures, 
sloughs, destruction of the peptic glands and ulcerations. 

Mercury bichloride, aside from its antiseptic use (see Antiseptics), 
is of great value when given internally, not only in syphilis, but in 
other states not associated with any such depraved condition. In 
diphtheria it may be used to prevent fibrinous exudation as readily as 
calomel, and in tonsillitis, where the inflammation is severe, it is often 
used with great service. 

When using a solution of bichloride of mercury as an antiseptic 
tartaric acid should be added to the solution to prevent the precipi- 
tation of the mercury in the form of an albuminate. 

In small amounts, that is -g 1 ^ to fa of a grain three times a day, 
the bichloride is one of the best remedies which we possess for the 
treatment of anosmia, be its cause what it may. 

Bichloride of mercury is of value in minute does of fa to -g 1 ^- of 
a grain in the ill-smelling green stools of summer diarrhoeas in 
adults and children, and it has been recommended that a solution be 
made J a grain in 5 ounces of water and a teaspoonful be given every 
hour until relief is obtained. This treatment is particularly useful in 
mueous diarrhoea, in which blood and mucus are thoroughly mixed. 
Patients in the dispensaries often speak of these passages as contain- 
ing " corruption," and others think them " lumps of flesh," owing to 
the masses of blood and mucus. Whether the disease be acute or 
chronic, the bichloride, used in the way just described, will be of ser- 
vice. In dysentery and the diarrhoea of adults the same treatment may 
be resorted to, using two teaspoonfuls of the solution instead of one. 
It is hardly necessary to add that the greatest care must be bestowed 
upon the diet and clothing. The author has treated a child with 
persistent diarrhoea for months with varying success, only to succeed 



OXIDES OF MEKCURY. 215 

when it was found that the abdomen was exposed to the air, aud the 
mother was forced to apply and keep on the child a flannel binder. 

In some cases in which an obstinate syphiloderm is present, half an 
ounce of corrosive sublimate aud one ounce of chloride of ammonium 
may be added to a warm bath. 

Half a grain of the bichloride of mercury in six ounces of water 
is said to be most efficient as an injection in gleet, if used every three 
or four hours. 

In all parasitic affections of the shin a solution of 2 grains ot 
bichloride to the ounce of water may be sopped on the part three 
times a day. A solution of perchloride of mercury (Liquor Hydrar- 
gyri Perchhridi) is officinal in the B. P. ; it is prepared by adding J 
grain of the perchloride of mercury to 1 ounce of water, with \ grain 
of ammonium chloride to hold it in solution. 



Biniodide of Mercury. 

Mercury Biniodide (Hydrargyri lodidum Rubrum, U. S. and B. P.) 
is a bright red powder, possessing irritating powers equal to or above 
those of the bichloride, and causing symptoms when taken in over- 
dose closely resembling those produced by the latter drug. Owing 
to the formation of the salt it is thought to be particularly useful in 
the latter stages of syphilis. The dose is -£§ to -^ of a grain. (See 
Syphilis.) An ointment (Unguentum Hydrargyri Iodidi Rubri, 
B. P.) is useful as an application in goitre and obstinate skin diseases. 

At one time it was thought that biniodide of mercury was a better 
antiseptic than the bichloride, but this is not a fact. 



Protiodide of Mercury. 

Mercury Protiodide (Hydrargyri lodidum Viride U. S.) is much 
more mild than the biniodide and is given for exactly the same pur- 
poses. The dose is ^ to J of a grain three times a day. 



Oxides of Mercury. 

The yellow and red Oxide of Mercury (Hydrargyri Oxidum 
Flavum, U. 8. and B. P. and Hydrargyri Oxidum Rubrum, U. S. and 
B. P.), reel precipitate, are used largely as a dressing for syphilitic sores 
when diluted about one-half with chalk or other powder. If used 
pure they are somewhat caustic. From the yellow oxide is made the 
Oleate of Mercury (Oleatum Hydrargyri, U. S. and B. P.), which is 
used for the same purpose as ordinary mercurial ointment. 



216 DRUGS. 

In intestinal and gastric indigestion, with foul belching and very 
ill-smelling stools which are due to intestinal sepsis, the yellow oxide 
is sometimes given in the dose of -^ to -^ of a grain in trituration. 
Mercurial suppositories (Suppositoria Hydrargyria B. P.) are used 
when a mercurial effect is desired without the danger of interfering 
with the digestion. gp^ 

Red Precipitate Ointment ( Unguentum Hydrargyri Oxidi Bubri, 

U. S. and B. P.) and the Ointment of the Yellow Oxide ( Unguentum 

Hydrarygri Oxidi Flavi. U S.) are largely used, diluted one-half with 

lard in chronic, seedy skin affections, in obstinate conjunctivitis and in 

granular lids. 

Ammoniated Mercury. 

White Precipitate or ammoniated mercury (Hydrargyri Ammo- 
niatum, U. S. and B. P.) is used in an ointment ( Unguentum Hy- 
drargyri Ammonicdi, U S. and B. P.) in various skin affections, 
generally diluted with lard. 

In ozcenct, whether syphilitic or not, Trosseau has recommended 
the employment of the following powder as a snuff: 

R. — Hydrarg. ammoniati . . . . . . gr. iv. 

Pulv. sac. alb. . . . . . . ^ss. 

M. — S. To be used as a snuff, after thoroughly blowing the nose. 

The Red Precipitate may be used instead of the white precipitate. 
This treatment removes the stench and may cure the complaint. It 
may, however, irritate the mucous membrane, in which case it should 
be used in the strength of 2 grains to the J ounce. 



Black Wash. 

Black wash (Lotio Hydrargyri Nigra, B. P.) is made by adding 
1 drachm of calomel to a pint of lime water. It is used for wash- 
ing syphilitic sores and wounds. 



Yellow Wash. 

Yellow wash {Lotio Hydrargyri Ilava, B. P.) is made by adding 
30 grains of corrosive sublimate to a pint of lime water, and is used 
for the same purposes as the black wash, but is much more stimu- 
lating. 



YELLOW SULPHATE OF MERCURY. 217 



Acid Nitrate of Mercury. 

The solution of mercuric nitrate (Liquor Hydrargyri Nitratis, U. 
8. and B. P.), acid nitrate of mercury, is an exceedingly active, 
penetrating caustic, so rapid in its effects that it seems to drop through 
the tissues. It may be employed on epitheliomata and large warts 
applied by means of a glass rod. This treatment may also be resorted 
to with advantage in lupus until the surface of the growth is level 
with the skin. The surrounding parts should be protected by lard 
or oil. 

As this treatment is very painful, the spot should afterward be 
covered with collodion. 

Citrine ointment ( Unguentum Hydrargyri Nitratis, U 8. and B. 
P.) is used in chronic skin diseases of the scalp aud trunk. It is too 
strong for ordinary use and should be diluted one-half or less with 
lard according to the stimulating effect required ; the dilute ointment 
is officinal in the B. P. as Unguentum Hydrargyri Nitratis Dilutum. 

Linimentum Hydrargyri, B. P., and Emplastrum Hydrarygri, 
U 8. and B. P., are used for the same purposes as is the ointment of 
mercury. 

Yellow Sulphate of Mercury. 

Hydrargyri Subsulphds Flavus, U. 8., has been used under the 
name of Turpeth Mineral as an errhine in chronic ophthalmia, and 
also as a prompt emetic in croup. It is quick and certain, and, it is 
claimed, does not produce depression. The dose for a two year old 
child is 2 to 5 grains repeated in 15 minutes if necessary. 

Incompatibles. — Bichloride of mercury should never be given with 
any other substance except chloride of ammonium, as it is incompat- 
ible with almost every other drug. With the iodide of potassium it 
may be used because the precipitate formed is at once re-dissolved, 
and the resulting mixture is highly alterative. 

Calomel should never be given with iodides or bromides, and hy- 
drochloric acid may convert it into the bichloride if it is present in 
any amount. 

One of the best ways to use mercury is in the form of triturates 
which may be used by triturating 1 parts of the drug with 90 parts 
of milk sugar. The minute subdivision of the medicament aids in its 
efficiency because of its more ready absorptiou. 



218 DRUGS 



METHYL CHLORIDE. 

Methyl Chloride is a colorless, easily liquefied gas with an odor 
resembling that of ether and chloroform, used to produce local anaes- 
thesia. It is usually kept in a siphon or in an ordinary bottle and 
applied to the skin in a spray, or better still, by means of a cotton 
tampon saturated with the liquid. 

Under these circumstance in a few minutes the skin becomes pale, 
afterward perfectly white and parchment-like looking. Local anaes- 
thesia is now complete and minor surgical operations, such as opening 
boils or abscesses, can be accomplished without pain. 



MEZEREUM. 

Mezereum, U. S., Mezerei Cortex, B. P., is the bark of Daphne 
Mezereum, a plant of Asia, Europe, and Great Britain. It is sup- 
posed by some to be possessed of extraordinary alterative power, but 
this is certainly a mistake, as its influence in this line is very feeble. 
It is, however, distinctly irritant, .and in overdose causes all the 
symptoms of gastro-enteritis. It is so irritant as to have been used 
externally as a counter-irritant. It enters into the compound syrup, 
fluid extract, and decoction of sarsaparilla, but is rarely, if ever, 
given alone. The offlciual preparations of mezereum are the extract 
{Extractum Mezerei, U. S.), the fluid extract (Extractum Mezerei 
Fluidum, U. $.), and the ethereal extract (Extractum Mezerei JEthe- 
reum, B. P.), all of which are used as external irritants. 



MUSK. 

Musk (Moschus, U. S. and B. P.) is obtained troni the preputial 
follicles of the musk deer of Thibet, and is a substance possessing 
the most remarkable penetrating powers, so far as odor is concerned. 
Very little of the musk for sale in the shops is pure, and most of it 
has never seen musk. Its price varies very greatly, but if sold for 
less than twenty-five cents a grain it is probably worthless. 

Therapeutics. — For some unknown reason musk acts as a diffusi- 
ble stimulant and supports the system. It is also an anti-spasmodic 
and nervous sedative. In all low fevers where the strength of the 
patient is fast ebbing away, and the nervous symptoms are those of 
the most advanced depression, rectal injections of musk in starch- 
water should be employed. The dose should be 5 to 10 grains. 
This drug is of value, both where nervous excitement and nervous col- 



MUSTARD. 219 

lapse are present, but is not to be employed until it is absolutely 
needed, to carry the man past a crisis. If frequently employed it 
loses its power, and the expense is a needless one. 

Musk is one of the best remedies in obstinate hiccough. The dose 
of the tincture (Tinctura J\Ioschi, U. S.) is 30 drops to 1 drachm, 
and of musk itself 5 to 10 grains. 



MUSTARD. 

Mustard is officinal in the form of Sinapis Alba, U. S., Sinapis 
Albas Semina, B. P., or white mustard, and Sinapis Nigra, U. S., 
and Sinapis Nigrce Semince, B. P., or black mustard. Both of them 
contain an irritant oil {Oleum Sinapis Volatile, U.S., Oleum Sinapis, 
B. P.) as their chief active constituent. 

Therapeutics. — Mustard is often used in the form of mustard 
flour as an emetic, when stirred up in water in the proportion of a 
tablespoon ful to a glass of water. It is also employed as a counter- 
irritant and a condiment. If given in excessive dose it will cause 
violent gastritis, and chronic gastritis is often set up by its constant 
use. It is contra-indicated internally in acnte gastritis and all 
similar states. 

When used as a counter-irritant it is applied to relieve the pain of 
colic, due to flatulence and acute inflammation, in muscular rheuma- 
tism and inflamed joints, in neuralgia, and at the nape of the neck in 
headache and cerebral congestion. When applied to the ordinary skin 
it will produce a bad burn if left on more than a few minutes, aud 
should be mixed with wheat flour in the proportion of J to J- for 
tender skins Children will not generally stand more than \ mus- 
tard. The plaster should be made with warm water or vinegar, or 
even a little brandy may be used. Mustard plaster (Cataplasma 
Sinapis) is officinal in the B. P. 

The scald or burn produced by mustard is peculiar in its slowness 
to heal, and in the fact that it is tender and reddened for days. If 
the burning of the mustard becomes excessive it should be treated by 
a piece of lint soaked in lime water and olive oil, half and half, or 
olive oil alone may be used. 

The oil of mustard is very irritant, and is almost epispastic in its 
effects It is only given in the atonic stomach of drunkards in the 
dose of J to J- a drop. Charta Sinapis, U. S. and B. P., or mus- 
tard papers, are sometimes called sinapisma, and these afford a ready 
means of carrying this counter-irritant. They are generally very 
strong, and should be covered by one or two layers of old and 
moistened linen to prevent too great an action. (See Counter-irri- 
tation.) The compound liniment (Linimentum Sinapis Compositum, 
U. S. and B. P.) is composed of the oil of mustard, castor oil, extract 
of mezereum, aud alcohol. 



220 DRUGS 



MYRRH. 



Myrrha, U. S. and B. P., is a gum resin obtained from Balsamo- 
dendron Myrrha, a tree of Arabia. It occurs in dark colored tears, 
and contains an active principle, myrrhin. 

Therapeutics. — Myrrh, in medicinal amount, is a stimulant to the 
circulation, the uterine, and the bronchial mucous membranes. 

In amenorrhoea, due to functional inactivity, or anosmia, " iron 
and myrrh " is a standard remedy. 

The tincture of myrrh, diluted one-half, is useful in ulcerated 
sore-throat as a gargle, and the pure tincture is sometimes applied 
with a small brush or the end of the finger, to spongy or tender 
gums. 

In leucorrhoea, depending upon uterine trouble, and in chronic 
cystitis, it is often of service. Sometimes it enters into expectorant 
mixtures for the later stages of bronchitis. The dose of the tincture 
(Tindura Myrrhce, U. 8. and B. P) is 10 to 30 drops. It also enters 
in the composition of Pilulce Aloes et Myrrhce, U.S. and B. P., dose 
2 to 5 pills, and Tindura Aloes et Myrrhce, U. S. and B. P., the dose 
of which is 1 to 2 iluidrachms. 



NAPHTHALIN. 

Naphthalin is a coal-tar derivative, and occurs in colorless mica- 
like crystals, possesses a peculiar smell, and is soluble in alcohol to 
some slight extent. After it is taken for some time, or even at once,. 
the patient will state that when he belches the gas has the smell and 
taste of burning rubber. 

The drug possesses distinct antiseptic power, and has been for 
this reason employed in certain gastric and intestinal diseases, asso- 
ciated with fermentative changes or dependent upon ulceration and 
organic lesions. In foetid diarrhoea it may be given as a deodorant 
and cure. 

When given to children, as in summer diarrhoea, the dose should 
be -J- to \ grain every 2 or 4 hours, but adults may take as much 
as 5 to 10 grains. More than this will disorder the stomach. The 
drug should be given in powder, in capsules, or with sugar. It has 
not been as widely employed as was expected when it first came 
before the profession, and certainly often fails to do good. 



NUTMEG. 

Myristica, U. S. and B. P., or Nutmeg is the kernel of the seed 
of Myristica Fragrans, an East and West Indian Plant, Mace being 



NITRATE OF SILVER. 221 

the outside covering of the same. Nutmeg is a soporific and nervous 
sedative exercising a pecular influence over the cerebrum. It is 
also used as a flavoring substance in somnifacient mixtures and is 
of value in prescriptions for serous diarrhoea. The oil ( Oleum Myris- 
tiece, U. S. and B. P.) is given in the dose of 1 to 3 drops. The 
spirit or essence (Spiritus Myristicce, U. 8. and B. P.) is used in the 
dose of 1 to 2 drachms. 



NITRATE OF POTASSIUM. 

Nitre (Potassii Nitras, U. 8. and B. P.) or saltpetre occurs in long, 
needle-like crystals and has a sharp, saline taste. Sal Prunelle is 
saltpetre melted and run into moulds. 

Next to the chlorate of potassium this is the most poisonous of the 
potassium salts and produces when taken in overdose violent symp- 
toms of gastro-enteritis. While it does not affect the blood it is 
more irritant than the chlorate. 

Nitrate of potassium is rarely employed at present, and has been 
properly put aside as inferior to the harmless vegetable potassium 
salts (the citrate, acetate, and bitartrate). If used in rheumatism the 
dose should be 1 ounce in a pint of barley-water or syrup of acacia 
and water to be taken in divided doses of a tablespoonful every three 
hours. Nitrate of potasssium papers (Charta Potassii Nitratis, U. 
8.) are made by dipping unsized paper in a solution of the salt of 
the strength of 20 parts of the salt to 80 parts of distilled water. 
They are rolled into cigarettes and smoked by asthmatics or burned 
in a pan and the fumes inhaled. 



NITRATE OF SILVER. 

Nitrate of Silver (Argenti Nitras, U. 8. and B. P.) is a heavy, 
crystalline solid salt of silver, readily soluble in its own weight of 
water. 

It is officinal as the pure nitrate (Argenti Nitras, U. 8. and B. P.) 
and as the sticks or fused rolls (Argenti Nitras Fusus, U. 8) or 
lunar caustic. The latter are never used in medicine internally, only 
the crystals being employed. Applied to the tissues of the body or 
other substances it causes a brown and finally a black stain which 
is due to the formation of an oxide of silver. 

Physiological Action. — Nitrate of silver is one of the few astrin- 
gent substances which are applicable to inflamed mucous membranes 
as it is, with lead, bismuth, and zinc, the only drug of the class which 
is not irritant as well as astringent. Locally applied it acts in pure 
form as a powerful caustic which is, however, very superficial indeed, 



222 DRUGS. 

as it coagulates the albumen with which it comes in contact and 
thereby forms a coat which protects the tissues beneath. 

The action of the drug upon the circulation, respiration, and sim- 
ilar vital functions is only partly known and has no relation to its 
employment in medicine. 

Nitrate of silver is eliminated from the system very slowly indeed. 

Poisoning. — Almost immediately after the ingestion of a poisonous 
dose of nitrate of silver, violent pain in the belly, with vomiting 
and purging, comes on. At the same time evidences of widespread 
gastro-enteritis develop. The abdominal walls are knotted and hard, 
and perhaps scaphoid. The face is anxious and livid and covered 
with a sweat. When the vomiting occurs, the ejecta are seen to be 
brown or blackish or even white and curdy. The lips are stained 
white, then brown, then black. In some cases the nervous symptoms 
are severe and convulsions with delirium may occur. The convul- 
sions are epileptiform. Death ensues either from the gastro-enteritis 
or from centric respiratory failure accompanied by a profuse exuda- 
tion of liquid mucus into the bronchial tubes. 

The treatment consists in the use of common salt, which is the 
chemical antidote, the employment of opium and oils to allay irrita- 
tion, and in the ingestion of large draughts of milk and of soap and 
water. The bodily heat must be maintained. 

Chronic Poisoning. — This is more common than the acute poison- 
ing and is quite frequently seen. The most prominent symptom is 
the slate-blue color of the skin which causes the individual to be 
most livid and death-like in appearance. 

Argyria, as the chronic poisoning is called, ensues from the con- 
tinued employment of the drug until it is deposited in the tissues. 
It is then found in every part of the body. 

The first signs of discoloration can generally be seen in a darken- 
ing of the conjunctiva over the sclerotic coat of the eye, or in a dark 
line on the inner part of the lips. 

The treatment of argyria is not hopeful so far as the color of the 
skin is concerned, but it may be improved by the use of iodide, of 
potassium to aid in the elimination of the poisou. 

Therapeutics. — Internally this salt is used as a cure for gastric 
ulcer, and is certainly the best remedy we possess if combined with 
extract of hyoscyamus or opium in pill form In chronic gastritis 
it is very useful, given in the same manner, where the patient is 
troubled with sour eructations or where mucous vomiting occurs 
after meals. When used in these states it should be given in \ to \ 
grain doses, half to one hour before each meal, in order that the 
stomach may be exposed to its effects and not protected by food. 

In intestinal ulceration the drug has been highly recommended by 
Dr. Pepper, but should be given in hard or keratin- coated pills in 
order that it may escape through the stomach without destruction. 
In ulceration of the cwcwn and rectum and in acute and chronic 



NITRATE OF SILVER. 223 

dysentery the trouble should be attacked by injections of nitrate of 
silver. If the csecum is involved the solution must be in large quantity 
to reach the part affected, but if the rectum is diseased the amount 
of liquid injected should not exceed four ounces, the bowel in either 
case being washed out by warm water beforehand to rid it of faeces. 
Soap and water must not be used for this purpose, as the soap which 
remains in the bowel will prevent the silver salt from acting. The 
strength of the solution employed should be 1 drachm to 3 pints ot 
water in csecal trouble, and 3 grains to each 4 ounces used in- rectal 
trouble. If the latter condition is very obstinate and chronic the 
strength may be raised to 5 grains to each 4 ounces. 

Whenever such a solution is used a solution of salt and water 
should be at hand and injected if the action is too severe or where 
the silver has acted long enough. 

Nitrate of silver is the only remedy of any value in idiopathic 
anterior and posterior spinal sclerosis, but often fails. 

Nitrate of silver has been largely used in epilepsy and chorea, but 
is now seldom so employed and does little good in most cases. 

Dr. William Pepper speaks highly of the continual administration 
of nitrate of silver in pill form in the dose of ^ to J grain through 
the entire attack of typhoid fever, and believes it greatly modifies the 
severity of the disease. 

Externally nitrate of silver is used for many purposes, and will 
often prevent the pitting of smallpox if used in the following manner : 
On the fourth or fifth day the vesicles are to be punctured by a 
needle dipped in a solution of nitrate of silver in the strength of 20 
grains to the ounce of water. Others simply paint the skin over the 
eruption with a solution of 5 to 10 grains to the ounce, claiming 
that it is equally effective and prevents inflammation and suppura- 
tion. 

Higginbottom has highly recommended the use of nitrate of silver 
over erysipelas, but the practice is not a common one and is now 
supplanted by better measures. (See Erysipelas.) In other inflam- 
mations of a superficial character nitrate of silver is of great value. 
Painted in strong solution over the scrotum in the early stages of 
orchitis or epididymitis it will often relieve the pain and swelling, 
and felons can sometimes be aborted by its early application over the 
surface of the finger. 

In all inflammations of the pharynx, larynx, fauces and mouth 
solutions of silver nitrate are to be used in varying, solution. Some- 
times after slight exposure the posterior wall of the pharynx suddenly 
becomes sore and raw, feeling as if the mucous membrane had been 
scarified. A solution of nitrate of silver will relieve this, and if it is 
employed in the strength of 60 grains to the ounce is said to be more 
efficacious and less painful than if weaker solutions are employed. 

In laryngecd phthisis a spray used from an atomizer in the strength 
of \ to 2 grains to the ounce of water may do good service. 



224 DRUGS. 

In whooping-cough Ringer recommends the use of a spray in the 
strength given above for the purpose of relieving the cough in its 
violence and frequency and of obtaining a good night's rest. The 
applications should be made when the stomach is empty as they 
bring on retching. The end of the atomizer must be within the 
mouth or the skin of the face will be stained. 

In gonorrhwa an injection of nitrate of silver of the strength of 
2 to 4 grains to the ounce is very useful in the later subacute stages. 

In uterine ulceration and leucorrhcea when the cervix is boggy and 
tender the application of the solid nitrate of silver stick is of service. 
Its use is often followed by headache about the vertex, and this is to 
be relieved by 10 grain doses of the bromides. 

In pruritus pudendi, a r ni, and vulvae a solution of 4 to 6 grains to 
the ounce should be painted with a camel's-hair brush over the parts 
to relieve the itching. The application is to be made from two to 
four times a day. 

Bed-sores may be aborted if, as soon as the skin reddens, a solution 
of nitrate of silver of the strength of 20 grains to the ounce is applied 
with a brush to the part. This measure fails in paralytics. 

Boils which begin in a small limited papule with a surrounding 
area of inflammation may be aborted by the use of a strong solution 
of this salt. 

In granular lids, conjunctivitis and similar affections about the 
eye the use of the nitrate of silver in stick form or in solution is 
largely employed. (See Conjunctivitis.) 

When it is desired to remove nitrate of silver stains they should 
be washed with a solution, made of cyanide of potassium 2J drachms, 
iodine 15 grains, and water 3 ounces. 

Administration. — The dose of nitrate of silver is J to J of a grain 
in pill form. Mitigated caustic, or diluted nitrate of silver (Argenti 
Nitras Dilutus, U. S. f Argenti et Potassi Nitras, B. P., is composed of 
equal parts of nitrate of silver and potassium nitrate and is used as a 
mild caustic. 

The drug when given continuously for a long time should be 
discontinued four or five days at the end of the second week, as it is 
so slowly eliminated as to accumulate in the body and cause argyria. 



NITRIC ACID. 

Nitric Acid (Acidum Nitricum, U. S. and B. P.), the strongest 
and most corrosive of the mineral acids, is a clear liquid becoming 
slightly yellow with age, acting, when in pure form, upon the tissues 
of the body as a powerful caustic. Applied to the mucous membranes, 
well diluted, it acts as a irritant and astringent and when taken in- 



NITKIC ACID. 225 

ternally acts as a stimulant to the secretory glands of the stomach 
and small intestines. 

It does not relax the bowels as does nitro-hydrochloric acid. 

Poisoning'. — When nitric acid is taken in concentrated form it 
produces a widespread gastro-enteritis, great pain in the mouth, oesoph- 
agus and abdomen, and finally death, from the inflammation in- 
duced, or from collapse. If the patient survives the acute stages he 
may die from secondary changes in the stomach and bowels, such as 
stricture or destruction of the peptic tubules. The stain made by 
acid about the mouth and clothes is deep lemon yellow. Renal irri- 
tation is often severe and the stools and urine may be bloody. 

The antidotes are any alkali of a mild type, as magnesium, chalk, 
or whitewash from the walls of the room. The use of oils and opium 
to relieve irritation and the proper maintenance of bodily heat. 

Therapeutics.- — Xitric Acid is used externally in medicine as a 
caustic for chancres and chancroids, the surrounding tissues being 
protected by oils or ointments. 

It may also be used on warts, in gangrene to destroy the tissues, 
and on phagedenic ulcers. Whenever the acid is to be applied a so- 
lution of soap and water should be at hand to neutralize its effects as 
soon as it has acted deeply enough. Nitric acid is also used externally 
in a dilute form, 5 to 30 drops to the ounce, as a stimulant and as- 
tringent to indolent ulcers. Internally, nitric acid is used as a tonic 
and astringent. In the oxcdic acid diathesis Avhen oxaluriais present 
nitric acid will give relief when nitro-muriatic acid cannot be obtained, 
although the latter is far more preferable. When small idcers or 
stomatitis exists in the mouth 8 drops of nitric acid at a dose, in water, 
will often be of service, but it should be taken through a tube to 
protect the teeth. In gastric indigestion, in which, soon after a meal, 
sour food regurgitates into the mouth, a few drops of nitric acid will 
often give relief. In intestinal dyspepsia coming on some hours after 
meals, and in which not only discomfort but pain may be felt in the 
hypochondrium, nitric acid with some simple bitter tonic is most 
efficient, and it will often cure the green diarrhoea of children, par- 
ticularly in the summer, bringing about these changes not only by 
its astringent power but also by its stimulating effect on the intestinal 
glands. Combined with Fairchild's Essence of Pepsin it will give 
relief in the chronic diarrhoea of children associated with dysentery, 
and in which the stools may be pasty or watery and at the same 
time ill-smelling. 

Ringer recommends the employment of nitric acid in the treatment 
of piles. The strong acid should be used and simply touched to one 
or two points, not swept over the whole surface. The pain is very 
slight, or none at all may be felt. A slough results, which when it 
comes away leaves a cicatrix which as it contracts diminishes the size 
of the pile. 

He also states that a lotion of dilute nitric acid in the proportion 

15 



226 DRUGS. 

of half to one drachm to a pint of water is of service in bleeding 
hemorrhoids, arresting the bleeding, constriuging the parts, and re- 
lieving the sensation of weight and fulness so often a pressing symp- 
tom. 

The dose of dilute nitric aoid (Acidum Nitricum Dilutum, U. S. 
and B. P.) is 3 to 15 drops well diluted and taken through a tube, 
to protect the teeth. 



NITRITE OF POTASSIUM. 

Nitrite of Potassium is a salt of potassium, used largely in modern 
medicine to take the place of nitrite of amyl, but possessing greater 
stability, and, therefore, more permanent in its effects. It is used in 
angina pectoris or heart-pang, in gastralgia and even in epilepsy. 
The dose is from 3 to 5 grains, although much larger doses have been 
employed. These larger doses are, however, not devoid of danger. 



NITRO-GLYCERIN. 

Nitro-glycerin is a compound which in its pure state is used largely 
as an explosive, but is employed in medicine, in a dilute form, as a 
useful drug in those instances where a somewhat rapid and powerful 
effect is to be exercised over the vascular system. Its physiological 
action is identical with that of the other nitrites, such as the amyl 
nitrite, except that it is not so fugacious as the latter, nor so per- 
sistent in its effects as the nitrite of sodium or potassium. The dose 
is 1 to 2 drops of a 1 per cent, solution in a little water or in pill, 
and no more than this may be employed at one dose. The drug is 
largely given in angina, pectoris, sometimes in epilepsy and chorea 
and in gastralgia. In cases of asthma dependent upon engorgement 
of the mucous membranes of the bronchial tubes it is very service- 
able. The solution used in medicine is too weak to be explosive. 
Tablets of nitroglycerin [Tabellm Nitro-glycerini, B. P.) each contain 

lio of a g rain - 



NITRO-HYDROCHLORIC ACID. 

Nitro-hydrochloric Acid {Acidum Nitro-hydroehlorieum, U. S.) is a 
dark red liquid giving off a distinct odor, of very caustic action, 
staining the tissues of the body a light yellow. It is officinal in the 
form of the dilute acid [Acidum Nitro-hydrochioricum Dilutum, U.S. 
and B. P.) which is often lemon yellow, in which case it is useless 



NITRO-HYDROCHLORIC ACID. 227 

except as an ordinary acid. According to the JJ. 8. P. it must be 
orange yellow. Neither of these colors is, however, proper when we 
wish to use the acid for its own peculiar effects, and the officinal 
dilute acid ought to be always supplanted by the freshly mixed strong 
acid and be of a dark current red color. If this cannot be obtained 
the physician should make it for himself by adding 4 parts of 
medicinally pure nitric acid to 16 parts of hydrochloric acid, allow- 
ing the mixture to stand in an open bottle until the fumes are no 
longer given off in excess, when it must be tightly corked and kept 
in a dark place. The acid ought to be freshly prepared every few- 
days. 

Poisoning. — The symptoms caused by poisonous doses are those 
of violent gastro-enteritis with vomiting and purging of bloody 
matters. Death may accur from perforation of the alimentary canal, 
from inflammation of the abdominal viscera, and from destruction 
of the peptic tubules or constrictions of the oesophagus or bowel. The 
treatment consists in the use of alkalies such as magnesium, lime, 
whitewash, soap, and oils, with opium to allay irritation. 

Therapeutics. — Nitro-hydrochloric acid is an invaluable remedy 
in many cases of indigestion arising either in the stomach or bowels, 
as it acts as a tonic and stimulant to secretion. Upon the biliary flow 
its action is quite marked, and it may cause bilious purging if pushed 
to any extent. It is therefore largely used in hepatic torpor, either 
acute or chronic, and in the early stages of hepatic cirrhosis should 
always be resorted to. In the chronic hepatitis of hot climates it is 
exceedingly useful, but it is not to be employed in acute sthenic 
hepatitis as it is a stimulant to the liver, which then needs quieting. 
When used in chronic hepatitis it should be given in full dose and 
pushed to its physiological limit, as evidenced by the bilious purging 
produced, or some other signs. In ordinary so-called biliousness, 
which is not biliousness, but intestinal indigestion, this acid is often 
of great service. (See Indigestion.) It is also of value in dysenteric 
diarrhoea, where the dysentery rests upon detective secretory action 
on the part of the glands which pour out the proper fluids for diges- 
tion, and in chronic diarrhoea its persistent use for a week or two 
should be tried. 

Administration. — The strong red acid should be given to the adult 
in the dose of 1 to 3 drops three times a day, well diluted, and taken 
through a tube after meals. If the patient is intelligent he should 
be ordered J an ounce of the pure acid and told how to drop it. If 
not, the physician must order it partly or entirely diluted in the 
prescription, and order it in so small an amount that it may be re- 
newed before it loses any of its power. Warning should be given 
of its effects on any clothes with which it may come in contact, aud 
care should be taken that the bottle is held well away from the face 
when the cork is withdrawn, as the acid, if it is fresh, may fly out 
and burn the eyes and face. 



228 DRUGS. 



NUX VOMICA. 

Nux Vomica ( U. S. and B. P.) is the seeds of the Stryehnos Nux 
Vomica, an East Indian tree. It contains two alkaloids, strychnine 
and brucine, and depends largely for its medicinal power on the 
former. 

Physiological Action. — When strychnine is given to man or the 
lower animals it increases reflex activity, respiratory rate, pulse-beat, 
and arterial pressure, acuity of vision and hearing, and causes general 
systemic irritation or excitement. 

Nervous System. — On the nervous system strychnine exerts its 
chief influence. It excites' the spinal cord in its motor tracts and 
probably increases the receptive activity of the sensory centres. It 
also has some slight influence in exciting the- conductive power of 
the motor and sensory nerves. In overdose it produces spinal or 
tetanic convulsions by an action exerted on the spinal cord. If 
death takes place from the drug the motor nerves are found to be 
depressed, partly as the result of the poisonous action of the strych- 
nine and party as the result of the exhaustion of the nerve-trunks 
by the convulsing impulses which they have carried. 

Circulation. — Nux vomica increases the force of the pulse- 
beat and the pulse-rate by a stimulation of the heart muscle and its 
ganglia, while the rise of arterial pressure is due to stimulation of 
the vaso-motor centre. If very poisonous doses are injected a fall 
of arterial pressure occurs instead of a rise, which is due to vaso- 
motor depression and paralysis. 

Respiration. — Strychnine is one of the most constant aud pow- 
erful stimulants to the respiratory centre that we have, and it in- 
creases not only the rate but the respiratory capacity. 

Temperature. — Ordinary doses have no effect upon temperature, 
but poisonous doses may raise it by reason of the convulsions. 

Elimination. — Strychnine is eliminated from the body by the 
kidneys as strychnine and strychnic acid. Most of it is oxidized 
and destroyed by the liver. 

Poisoning'. — Where a poisonous dose of strychnine is taken it acts 
either suddenly or gradually. If suddenly, the man or animal may 
be thrown several feet, and become rigid, by contraction of his mus- 
cles, without any premonition. 

If the onset is gradual, some stiffness at the back of the neck and 
uneasy startings may precede the general nerve-storm. The convul- 
sions are tetanic or tonic, and the body is thrown into opisthotonos, 
that is, resting on the head and heels at each convulsion. 

Sometimes the trunk is twisted side- ways, or with the back in the 
air. (Emprosthotonos.) The eyes are open and fixed, the corners 
of the mouth drawn back into visits sardonicus, and the respiration, 
during a severe convulsion, is entirely set aside. 



NU5 VOMICA. 229 

The slightest noise, draught of wind, or touch, may cause a convul- 
sion, or convulsion after convulsion, because the sensory impulse, 
reaching the spinal cord, causes a spasmodic motor impulse to be 
sent out. 

The convulsions are not absolutely continuous, but periods of utter 
or partial relaxation occur, during which the patient breathes easily. 
The cramp-like contractions of the muscles are exceedingly painful, 
and the patient either dies of cramp asphyxia — that is, through failure 
of respiration, because his chest muscles are locked in spasm, or 
much more rarely, from exhaustion. 

Treatment of Poisoning. — The attendant should give at once, if 
no symptoms have yet appeared, inhalations of nitrite of amyl, and 
meanwhile employ the stomach-pump, using the nitrite to prevent 
any convulsive tendencies during the operation. Draughts of water 
containing tannic acid as the chemical antidote are to be adminis- 
tered, and after the stomach is washed out 60 grains of bromide of 
potassium and 20 grains of chloral in solution are to be given. 
These are the physiological antidotes, for the bromide of potassium 
depresses the sensory side of the spinal cord, and the chloral depresses 
the motor tracts. If the convulsions prevent swallowing the patient 
must be chloroformed with care, and the physiological antidotes 
given by the rectum in starch water, muscular relaxation being 
maintained until the drugs are absorbed. Ether cannot be used, as it 
is too irritant and too slow. Nitrite of amyl is also a physiological 
antidote, but it is useless if a complete convulsive attack is present, 
as it cannot be inhaled if the chest is immovable. 1 

Neither can any other relaxant, such as chloroform, be used 
under those circumstances. These drugs should be gently given be- 
tween the paroxysms. If relaxation does not occur the nitrite of 
amyl should be injected hypodermically. 

While a light touch may produce a spasm a firm, hard grasp of 
the limb often relieves the pain of the cramp. Sensation is pre- 
served unless the asphyxia destroys it. 

Differential Diagnosis. — The convulsions do not resemble epi- 
lepsy, because they are so distinctly tonic, and never clonic. From 
tetanus strychnine poisoning is to be separated by the fact that in 
tetanus the locking of the jaws comes first, while in strychnine pois- 
oning it comes last. The convulsions of tetanus rarely, if ever, 
completely relax, while those of strychnine do have periods of re- 
laxation. There is a different history in each case. In one, perhaps, 
an injury, as of a nail run into the foot ; in the other, of a dose of 
poison having been swallowed. 

The differential diagnosis from hysterical convulsions is more 
difficult. The convulsions are rarely so persistently tonic in hysteria, 
while the peculiar expression of the hysterical type is often seen in 

1 See article by author in the Boston Medical and Surgical Journal, November, 1884. 



230 DRUGS. 

this disease. The history of the patient, if obtainable, will throw 
much light on the case, and aid very materially in the separation of 
the two conditions. 

As the treatment of all these states is virtually identical the em- 
ployment of the measures suggested may be resorted to in each in- 
stance, and the diagnosis made afterward. 

Therapeutics. — Nux vomica, or its alkaliod, is used for several 
purposes in medicine. Owing to its bitter characteristics it may be 
employed as a simple bitter tonic or as one especially influencing the 
nervous system. It may also be used as a respiratory, cardiac, and 
ocular stimulant. 

In cases of functional nervous atony, or depression, strychnine does 
good, but in organic disease, if used during the period of acute 
inflammation, as after an apoplexy or in acute infantile palsy, it is 
distinctly harmful. Some cases of apoplexy can never take the 
drug without a spasm coming on in the paralyzed part or parts. 
In acute or subacute neuritis strychnine ought never to be used in 
any way whatever, as the nerves are already inflamed and are not to 
be still further irritated. In progressive lead palsy large doses should 
be used constantly to stop the progress of the disease, iodide of potas- 
sium also being used to eliminate the lead. 

In amaurosis dependent upon eye-strain or the excessive use of 
tobacco and alcohol strychnine is almost a specific, and in eye- strain 
resulting from insufficiency of the ocular muscles it does great good, 
curing the weakness and improving. the condition of the muscles. 
According to de Schweinitz, a patient should use ascending doses of 
the tincture of dux vomica, beginning with 3 drops three times a 
day, and increasing the amount 2 drops a day until distinct physio- 
logical effects are produced. Sometimes 60 drops may be used in 
twenty-four hours after tolerance is reached. 

In dyspnoea, from any cause, such as that of old persons with 
winter cough or bronchorrhoea, in emphysema, phthisis, and in idio- 
pathic shortness of breath, strychnine is of service, and it is a valu- 
able drug for the treatment of opium-poisoning, preserving the 
reflexes and stimulating the respiratory centre. 

In atony of the bowels strychnine is of service, and is to be added to 
purgative pills to avoid their depressing after-effect on the intestines. 
Where a lesion exists in the brain, strychnine may be used to keep 
up the nutrition of a limb which is paralyzed, but if the palsy be due 
to disease of the trophic cells in the spinal cord, it does little good 
except to stimulate the remaining cells to greater effort. 

According to Kinger, sick headaches, due to errors in diet and 
without much nausea, can be put aside for the day by the use of a 
drop of the tincture in a teaspoonful of water every five or ten 
minutes until 10 drops are taken. 

Administration. — Abstract of mix vomica (Abstractum JVucis 
Vomicae, U. S.) is given in the dose of J to 1 grain ; the extract 



opium. 231 

{Extractvm Kueis Vomica', U. 8. and B. P.), dose J to J of a grain; 
the fluid extract {Extractum Nucis Vcmicce Fluidum, U. S.), dose 1 
to 5 drops; the tincture (Tinctura Nucis Vcmicce, U. S. and B. P.), 
dose 5 to 80 drops. Strychnine Sulphas, U.S. and B. P., is given 
hypodermieally in the dose of -£$ to ^V °f a g ram a]Q d by the month 
in the same amounts. 



OPIUM. 

Opinm ( U. S and B. P) is the jnice or milky exudation appearing 
on the surface of the unripe capsules of White Poppy or Papaver 
Somniferum, a native plant of -Asia, now grown in many other parts 
of the world. 

Good opium, according to the U. S. P., should contain at least 9 
per cent, of morphine. 

The chemical composition of this drug is very complex, no less 
than seventeen alkaloids having been obtained from it, the most im- 
portant of which are Morphine, Codeine, Narcotine, Thebaine, Nar- 
ceine, Papaverine, Pseudomorphine, and Laudanine. It also con- 
tains Meconic Acid and Meconine. 

Physiological Action. — Opium, when given in full dose, produces 
in the lower animals, such as the frog, violent spinal convulsions; 
in the dog, great increase in reflex activity, and in man deep sleep, 
the spinal symptoms being in abeyance. 

Nervous System. — Opium has a double action on the nervous 
system. It quiets the brain but excites the spinal cord. In the 
frog, which has no brain of any size, the spinal action predominates ; 
in man, whose brain is proportionately larger than his spinal cord, the 
cerebral effect is the dominant influence. In the animals between the 
frog and man it either produces convulsions and sleep, or sleep alone. 
If the dose is large, the spinal cord becomes depressed and the reflexes 
fail. The nerve-endings are also somewhat depressed under these 
circumstances. 

Circulation. — Small therapeutic doses of opium have no effect 
upon the circulation, but large ones slow the pulse, increase its 
force, raise arterial pressure and cause the respirations to become 
deepened and full and at the same time a little slower. 

The slowing of the pulse depends upon stimulation of the 
pneumogastric nerves peripherally and centrically ; the increase in 
pulse-force rests upon the stimulation of the heart muscle and its 
ganglia ; the rise of pressure is due to the increased heart action 
and vaso- motor stimulation. The respiratory changes depend on 
the action of the drug on the respiratory centre. 

In poisoning all these changes are more marked, and finally go on 
into a rapid running pulse and great depression, due to a reversal of 
all the influences named. 



232 DRUGS. 

Respiration. — In very minute doses opium is a feeble stimulant 
or at least uot a depressant. In overdose it is one of the most power- 
ful paralyzants of the respiratory centres in the medulla oblongata, 
causing death in this way. 

Temperature. — The temperature is raised slightly by fall doses 
and lowered by poisonous ones. 

Tissue-waste, — Opium acts as a protective to tissue-waste, 
decreasing the elimination of urea and other evidences of nitrogenous 
break-down. 

Elimination. — The drug escapes if given in excess as morphine, 
but most of it is destroyed in the body. 

Pupil. — Opium contracts the pupils by a centric stimulation of 
the oculo-motor nerves and by stimulating the sympathetic. 

Stomach, Intestines, and Secretion. — Opium depresses the 
motor activity of the stomach and intestines and thereby produces 
constipation. 

It does this by stimulating the splanchnic inhibitory fibres of the 
intestine and thereby preventing peristalsis. In very large doses it 
increases peristalsis by paralyzing these fibres. 

Opium checks every secretion in the body except the sweat. 

Acute Poisoning. — When opium is taken by man in overdose it 
causes drowsiness, deep sleep, full breathing, a slow, full pulse, a 
warm, dry skin, contracted pupils, and pleasant, or, more commonly, 
in the Anglo-Saxon race, disagreeable dreams or no dreams at all. 

Preceding this period there may be a brief one, during which the 
person feels self-satisfied and contented. The duration of this agree- 
able sensation only lasts a short time, and if the dose is large does 
not occur or at once passes off. It has been called the first stage, while 
the more marked symptoms just described have been grouped into 
the so-called second stage. 

During the sleep of the second stage the patient can be roused by 
shouting in his ear or by violent shaking, but sinks back into slumber 
at once on being let alone. 

The face is suffused and reddened and may be finally distinctly 
cyanotic. All of these symptoms resemble those of congestion of the 
brain. The breathing may be puffing and stertorous. When the 
patient is awakened he breathes more rapidly, and for this reason 
the duskiness of the face disappears and the normal hue returns. 
Death never occurs in the second stage of opium poisoning from the 
poison alone, but if disease is present death may take place at this 
time. 

The third or fatal stage emerges from the second by a gradual 
process so that no abrupt line of separation can be noted. The face 
becomes at first more cyanotic, then pale and livid, the respirations 
which have been 8 to ]0 to the minute, are now only 4 or 5, and 
finally such prolonged pauses occur that all hope of another respira- 
tion is lost by the attendant. While the slow breathing is at first 



opium. 233 

deep it now rapidly becomes shallow, and relaxation is present to the 
greatest degree. The skin, previously dry, is wet with the sweat of 
death, the patient is so deeply narcotized that nothing can arouse him 
and dies from respiratory failure, although the heart ceases almost 
simultaneously from the asphyxia. The pupils do not dilate in the 
third stage, except in the relaxation of death. 

Treatment of Acute Poisoning. — After employing the usual 
methods resorted to with the object of unloading the stomach, and 
after giving tannic acid as the chemical antidote, the patient should 
receive one or two cups of strong black coffee, hot and concentrated. 
The heat is useful in maintaining bodily temperature and the caffeine 
stimulates the respiratory centre and keeps the man awake. Coffee 
should be used even before any symptoms come on in order to put 
them off if possible. If atropine be at hand and the respirations are 
becoming very slow yj-g- of a grain should be given hypodermically, 
but should not be repeated after the respirations increase to 10 or 12. 
The pupil is no guide as to the action of atropine, as the action of 
these two drugs on the eye is not antagonistic. 

Alcoholic stimulants may be called for, and ammonia as a cardiac 
and respiratory stimulant may be resorted to. 

In the third stage heat should be applied to the trunk and 
extremities. 

Much emphasis has been placed on keeping the patient awake, and 
it has been thought that the cause of death was the deep sleep. 

This is not so. The man must be kept awake in order that he 
will supplement the efforts of his depressed respiratory centres by 
voluntary breathing. If he sleeps he forgets to breathe, and sleep 
means death for this reason and not because sleep is death itself. 

Besides the use of the hot strong coffee, just named, the patient 
may be kept awake by lashing him with switches or by keeping 
him walking up and down between two attendants. Both of these 
measures are reprehensible if anything better can be done, the first 
because it covers the patient with cuts and bruises, the second because 
it may aid in the production of death by exhaustion. If an ordinary 
medical electric battery is at hand the. full force of the current may 
be allowed to come in contact with the skin from two small poles 
wet with salt water, or better still the dry or wire electric brush 
should be swept over the body while the negative pole is held in the 
hand of the patient or pressed against his skin. This causes the 
most exquisite pain in the normal individual, but if the brush is 
kept moving will not cause any bruises or discoloration. The 
previous use of strychnine by reason of its action on the respiratory 
centre and its influence on the spinal cord and nerves is of great 
service. (See Asphyxia.) Artificial respiration may be resorted to. 

Chronic Poisoning. — Morphine or opium when taken constantly 
generates a habit. The person, or morphine-habitue as he is some- 
times called, depends for a comfortable existence on the drug and 



234 DRUGS. 

day by clay increases his dose until the most extraordinary amounts 
are taken by the stomach, or by means of the hypodermic needle. 
If the drug is withheld a train of symptoms typifying depression or 
exhaustion ensue. The pulse is scarcely to be felt, horrible mental 
depression and melancholia come on, the miserable man or woman 
wrings his or her hands, and begs, screams, howls or yells for mor- 
phine, only to break down and cry at its withdrawal. Diarrhoea, of 
a serious type and most violent character, with cramps in the muscles, 
may assert itself, and must be controlled by astringents and active 
treatment, as far as possible free from opium. 

A characteristic symptom of chronic opium-eating is the develop- 
ment of the most remarkable and clever lying, in previously truthful 
persons. In the breath that the patient begs the physician to cure 
him and not give him another dose, he will lie to obtain the drug in a 
surreptitious manner and may even have the drug in his mouth at 
the moment he speaks. It will often be found hidden in the seams 
of the clothing in small packages, and the nurse should be absolutely 
reliable and forever on the watch, lest the drug be obtained. Any 
sudden improvement on the part of the patient should be placed to 
the credit of more morphine, not to professional skill. 

Treatment. — The best way to treat such cases is to " taper off " 
the daily dose, and to decrease a sixth or fourth of the total custom- 
ary amount each twenty-four hours. The entire stoppage of the drug 
is unnecessarily severe and its withdrawal in a slower manner than 
that named is simply prolonging the treatment beyond reasonable 
limits. Cocaine has been used to tide over the crisis after the with- 
drawal of morphine, but too frequently the patient passes from opium 
to the cocaine and finally to the alcohol habit, both of which are 
equally bad. If the circulation flags digitalis may be given and the 
remaining symptoms treated as common sense indicates. 

Sometimes paregoric is taken in excess, and the writer has seen 
and treated a case under the care of Dr. Wood which took over a 
pint of paregoric every day. 

When a mother is an opium-eater the newborn child often suffers 
from collapse on the second or third day after its birth, owing to the 
lack of its customary dose of opium. 

Therapeutics. — Opium is used for relief of five great conditions 
which will be spoken of seriatim, the minor uses of the drug being 
considered afterward. 

Pain. — Opium, as is known to every one, is the best remedy that 
we possess for the relief of all forms of pain, except in those in- 
stances where neuralgia exists and where antipyrine and its fellow- 
compounds exceed it in medicinal value. In one form of pain the 
drug is not to be employed, namely, that arising from Cerebral Con- 
gestion or Cerebritis, for it is distinctly contra-indicated in these affec- 
tions, as it makes them worse. In meningitis, however, opium is of 
great service, either alone or combined with mercury in sthenic cases. 



opium. 235 

In cases of renal and hepatic colic associated with spasm, and in 
dysmenorrhea, belladonna and opium given together will relieve the 
spasm and pain, and jet so counteract each other elsewhere in the 
body as to be devoid of effect upon other organs. Persons suffering 
from pain will always bear very much larger amounts of opium than 
painless individuals. 

Insomnia. — Opium while capable of producing sleep in almost 
every case to which it is given, save in those persons who by reason of 
idiosyncrasy are made wakeful by it, is only to be used in those instances 
where the sleeplessness is due to pain. If constantly used in insomnia 
or in pain, the opium habit is rapidly obtained, and for this reason 
the use of the drug should be alternated with chloral, cannabis indica, 
and other soporific drugs. 

In some cases chloral and morphine when given in combination 
will so act upon the brain as to produce sleep in very small doses. 

In the insomnia of typhoid fever, opium may be used, particularly 
during convalescence, but must be employed most carefully. 

Inflammation and Irritation. — Opium seems to possess some 
influence over inflammation which we cannot explain, and small and 
large doses are particularly valuable in inflammations of serous 
membranes, such as peritonitis, meningitis, and pericarditis. It allays 
the nervous excitement and anxiety following hcemoptysis, and the 
intense unrest caused by itching skin diseases, as, for example, the 
irritation of smallpox. Sometimes intense irritation or inflamma- 
tion produces so great an effect upon unstriped muscular fibres as to 
cause spasm or paralysis, as in the retention of urine, cystitis or the 
constipation following inflammation of the bowels from irritating 
foods ; under these circumstances the employment of opium is indi- 
cated, and usually is very successful. In irritative coughs morphine 
does good, given in syrup of w r ild-cherrv bark, in the dose of y 1 -^ to 
y 1 ^ of a grain. Wherever the cough is in excess of the expectoration, 
that is, greater than is necessary to free the lung from mucus, mor- 
phine may be given in small closes. If the lungs contain more rales 
after than before its use it must be stopped. 

In strangury and reeled inflammation, provided it is not an acute 
catarrh, after operation on the pelvic organs and in cystitis, sup- 
positories, in the strength of J or J of a grain of the watery extract of 
opium, are very useful. In excessive vomiting from any cause, ex- 
cept it be from a previous dose of opium, injections of laudanum and 
starch-w r ater, with a little bromide of sodium, will be found of value. 
(See Vomiting.) 

For sprains and bruises lead-water and laudanum is one of the best 
applications. If the skin is broken laudanum may be used alone to 
relieve pain, and, by its alcohol, to act as an antiseptic. Opium is 
also a useful drug in internal and external burns, to allieve the pain 
and irritation. 



236 DRUGS, 

Over-secretion. — In serous diarrhoea, diabetes insipidus and 
mellitus, and in over-secretion of all secreting surfaces except the 
skin, opium may be used. 

It is said to decrease the amount of urine before decreasing the 
amount of the sugar in diabetes. 

Opium should not be used in mucous diarrhoea until after the 
mucus already present is swept out of the intestinal canal by castor 
oil or magnesium sulphate. Minute doses of -^ to -^ of a grain of 
morphine will sometimes check summer diarrhoea in children at once 
when given hypodermically. 

Systemic Strain. — In prolonged strain upon the system, as in 
great physical effort, or more frequently in old age, to smooth out 
the remaining years of life, and decrease worry, opium is useful. 
In asthenic fevers it is thought to be supportive, but its use is apt to 
cause so many other conditions, such as constipation, anorexia, or 
mental depression, that alcohol is much better for this purpose. In 
very advanced phthisis it is often justifiable to give enough opium to 
keep the patient free from pain and discomfort for the remaining 
hours of his life, but care must be taken that the dose does not in- 
terfere with his breathing, and so hasten death. 

In muscular rheumatism and similar states, where a " cold " has been 
taken, opium in the form of Dover's powder will often produce a 
cure particularly if combined with hot drinks and a hot foot-bath. 

In heart disease, particularly of the mitral valves, the patient can 
often only breathe easily while awake, starting up when he falls 
asleep, and gasping for breath. It is stated by some writers that 
morphine will relieve this. state and permit sleep, but that it will not 
be of service in aortic disease. While this may be partly true, the 
drug will often give great relief in all forms of cardiac dyspnoea, 
and ought always to be tried. Care should be taken that the first 
dose is small, as in some instances it increases the discomfort. The 
relief is supposed to be due to cardiac stimulation by the drug, and 
while this is, no doubt, correct, other cardiac stimulants, such as 
digitalis, will fail when morphine succeeds. The presence of cyano- 
sis and lividity is said to be no contra-indication to the hypodermic 
use of morphine under these circumstances, provided the dose is a 
reasonably small one. 

Administration.— Opium itself is used in the form of the powder 
(Pulvis Opii, U. S.) in the dose of from \ to 1 grain. The solid 
preparations are the denarcotized opium {Opium Denarcotisatum, U. 
8.), which is deprived of its narcotine, dose J to 2 grains, the pills 
of opium (Piluloe Opii, U. #.), each 1 grain, and the watery extract 
(Extractum Opii, U. S. and B. P.), dose J to | a grain. Of the 
liquid preparations we have paregoric (Tinctura Opii Camphorata, 
U. S., Tinctura Camphorw Composita, B. P.), dose 1 drachm to 2 
tablespoonfuls ; laudanum {Tinctura Opii, U. S. and B. P.), dose 10 
to 30 drops; the deodorized tincture [Tinctura Opii Deodorata, 



SULPHATE OF MORPHINE. 237 

U. S.), dose 10 to 30 drops ; the Vinvm Opii ( U. S. and B. P.), or, 
as it is sometimes called, Sydenham's laudanum, dose 5 to 10 drops; 
and Acctum Qpii, TJ. 8., or Black Drop, close 5 to 10 drops. 

Under the name of Dover's powder (Pulvis Ipecacuanhas et Opii, 
TJ. S.), a powder containing one grain of powdered opium, one grain 
of powdered ipecac, and eight grains of sugar of milk, is largely 
used. This is more efficacious if divided into fifths and taken in 
divided doses. The tincture of ipecac and opium (Tinctura Ipecac- 
uanhas et Opii, TJ. S.) is given in the dose of 4 to 15 minims. 

All the liquid preparations of opium are 10 per cent, strong except 
paregoric, which is much weaker. 

The preparations of opium officinal in the B. P. are : Confectio 
Opii, dose 5 to 20 grains ; JExtractum Ojni Liquidum, dose 4 to 20 
minims ; Pulvis Opii Compositus, composed of opium, pepper, gin- 
ger, caraway fruit, and tragacanth, close 2 to 5 grains ; Tinctura Opii 
Ammoniata, close J to 1 drachm; and Trochisci Opii (^ grain of 
opium in each), dose 1 to 4. 

Pilula Saponis Composita, B. P., is purely a preparation of opium. 
It is sometimes necessary to give this drug to patients without their 
knowledge, and it may be prescribed in this way, the patient not 
learning from the prescription the nature of the medicine. 

The B. P. also recognizes a liniment (Linimentum Opii), and a 
plaster (Emplastrum Opii), for local application, and an enema 
(Enema Opii), composed of J a drachm of the tincture of opium and 
2 ounces of starch mucilage. 



Sulphate of Morphine. 

Sulphate of morphine (Morphince Sulphas, TJ. S. and B. P.) is 
given in the dose of J to J grain, either by the mouth or hypo- 
dermically. Besides the sulphate of morphine we have the acetate 
( Morphince Acetas, TJ. S. and B P.), and the muriate (Morphince 
Hydrochloras, TJ. S. and B. P.), both given in the dose of \ to J 
grain. In the TJ. S. Pharmacopoeia of 1870 a solution, Liquor 3Ior- 
phince Sulphatis) was officinal, dose 1 to 2 drachms, but it is no longer 
officinal, and should not be called for. Magendie's solution is six- 
teen times as strong as this liquor (16 grains to the ounce) and is not 
officinal. The words u Liquor Morphinse Sulphatis" will generally 
cause Magendie's solution to be dispensed in New York State, and 
care should be taken that poisoning does not result. Pulvis Morphince 
Compositus, TJ. S., is given in the close of 10 grains; troches of 
morphine and ipecac (Trochisci Morphince et Ipecacuanhce, U. S.), 
are given 1 or 2 at a time. 

The following preparations of morphine are officinal in the B. P. : 
Liquor Morphince Hyclrochloratis, dose 10 to 60 minims; Tinctura 



238 DRUGS. 

Ohloroformi et Morphince, dose 5 to 10 minims ; Suppositoria Mor- 
phines and Suppositoria Morphince cum Sapone, each suppository 
containing \ grain of morphine; Trochisci Morphince and Trochisci 
Morphince et Ipecacuanhce, each lozenge containing -^ of a grain of 
morphine, dose 1 to 4. Liquor Morphince Acetatis is given in 30 
to 60 minim doses. Injectio Morphince Hypodermica, B. P., con- 
tains 1 grain of the acetate of morphine in each 10 minims of water. 
Codeine (Codeina, B. P.) is given in the dose of J to 1 grain. (See 
page 137.) 

Ordinary opium is apt to produce nausea and depression, as already 
stated, while the denarcotized opium is deprived of its narcotine, this 
being one of the chief causes of these disagreeable symptoms. The 
deodorized laudanum is substituted for the ordinary laudanum for 
the same reasons. Morphine is used to relieve pain rather than 
opium, because it does not cause so much constipation, but opium is 
better to check diarrhoea. Paregoric is particularly useful in diar- 
rhoea because it contains a volatile oil and camphor. 

Untoward Effects. — Opium in many persons produces after its 
primary influence great nausea, and sometimes vomiting. The men- 
tal depression may be simply overwhelming and the very fact of 
having to drag out existence is a curse. These symptoms are said 
to be largely done away with by the use of 20 grains of bromide of 
potassium, which must be taken with the drug, and by employing 
the preparations of opium largely devoid of narcotine such as the 
deodorized tincture. (See last page.) After the symptoms come on, 
coffee and stimulants may be used. 

Children bear opium badly, and some children are very much 
more susceptible than others to its influence. 

One-eighth grain of morphine has caused death in an adult when 
given hypodermically. If the drug enters a vein the patient may 
give one gasp and fall back apparently dead. Sometimes the drug 
causes collapse, or in other cases an eruption over the body. 

Incompatibles. — Morphine is incompatible with tannic or gallic 
acid or astringent solutions containing them, with alkalies such as 
potassium, sodium, and ammonium, but the chloride of ammonium is 
not incompatible. With tincture of chloride of iron it forms a deep 
red color. (Mecouic Acid.) 



OXIDE OF ZINC. 

Commercial oxide of zinc (Zinci Oxidum Vencde) is not used in 
medicine, but in the purified form is largely employed in the shape of 
Zinoi Oxidum, U. 8. and B. P., which is insoluble in water. In the 
form of the oxide of zinc ointment ( Unguentum Zinoi Oxidi, U. S. 



OXYGEN, OXYGEN WATER, AND OXYGEN PEROXIDE 239 

and B. P.) this salt affords one of the most generally used applica- 
tions in skin diseases, burns and sores. 

In all states where the surface of the skin is dry it is contra-indi- 
cated, but where the eruption is moist it is useful. In the chloasma 
of pregnancy the following prescription is of service: 

R. — Zinci oxidi. ....... gr. iij. 

Hydrarg. ammoniat. . . . . . gr. jss. 

Olei theobromse ...... ^ijss. 

Olei ricini. . . . . . . . 5 i j ss . 

Essent. rosse ....... gtt. x. 

M. S. — Apply to the face night and morning. 

In eczema with many vesicles use 

R. — Pulv. camphorse . . . . . gss. 

Pulv. zinc, oxidi . . . . . . ^iij- 

Glycerinee gtt. xl. 

Unguent, benzoiniati ..... ^j. 

M. S. — Apply to the part or precede it by powdered bismuth. 

In the powdered form zinc oxide is useful in intertrigo, and in 
conjunctivitis. With bismuth subnitrate and pepsin, it is largely used 
by some practitioners in the summer diarrhoea of infants or adults. 

In the night sweats of debility or of phthisis oxide of zinc in the 
following formula? has been highly recommended, but probably 
depends largely for its action on the second ingredient. 

R. — Zinci oxidi ....... gr. xxx. 

Ext. belladonnse . . . . . . gr. iij 

M. — Ft. in pill, No. x. S. One at night before going to bed. 

Bartholow recommends the oxide of zinc for asthma and ivhoop- 
ing- cough given, as above, to an adult. 



OXYGEN, OXYGEN WATER, OXYGEN PEROXIDE. 

The gas oxygen is now widely used in medical and surgical prac- 
tice in one of these three forms as follows : By the inhalation of the 
gas itself from a cylinder in which it is compressed until 40 gallons 
occupy a very small space; by drinking oxygen water, which is 
distilled water saturated with the gas, and finally, by the use of the 
dioxide or peroxide of hydrogen which is applied locally to diseased 
surfaces. 

Inhalations of oxygen are useful in the second and third stages of 
pneumonia where the patient is about to die from deficient aeration 
of the blood with resulting heart-distention. It is also of value in 
advanced bronchitis, particularly of old persons, and for the resuscita- 
tion of persons asphyxiated with coal-gas (Hare and Martin). In 
phthisis and other exhausting diseases it will allay dyspnoea and 
oppression. 



240 DKUGS. 

Id the preparation of the solution of oxygen gas the water must 
be distilled so that it may be as free from other gases as possible. 
The bottling should be done under a pressure of 150 to 200 pounds 
and the contents drawn off by means of a tap such as is used in 
siphons or for champagne bottles. Birch, of England, has found 
that the addition of a little nitrous oxide gas to this water adds 
piquancy to its taste and increases its stimulating effects. The value 
of this preparation is undoubted and when taken into the body has 
proved of the greatest service in chronic dyspepsia, persistent vomiting, 
and headaches both digestive and neuralgic. 

In constipation depending upon intestinal atony, the gas is said to 
give relief if the solution be taken just before going to bed. It is 
hardly necessary to state that the water should be swallowed as soon 
as possible after it is taken out of the bottle which contains it. In 
some cases where general systemic torpor is present, oxygen water 
taken after each meal, or even more frequently, may be used with 
advantage. One or two tumblerfuls may be taken each time. 

The peroxide or dioxide of hydrogen is a colorless, transparent, 
odorless syrupy fluid, of a specific gravity of 1.452, with a harsh, 
bitter taste, and is readily soluble in water. It is rarely used in its 
pure form, but should be employed in the strength of 2 to 5 per 
cent, with water, which strength is the proportion generally sold as 
the pure article. As much of the solution sold is worthless the fol- 
lowing test for its purity has been recommended by Wallian: 

Place a few crystals of permanganate of potassium in a test tube 
and add to it 1 or 2 drachms of the solution. The violence of the 
resulting effervescence is in direct ratio to its value as a remedial 
agent and to its purity. 

It is used as an effective application to ulcers of the acute and 
chronic form and upon burns and scalds. In the presence of sinuses 
the liquid should be used as in ordinary irrigation and the wound 
dressed antiseptically immediately afterward in the ordinary manner, 
or as desired by the surgeon. Tubercular abscesses are said to yield 
to its influence with extraordinary rapidity. 

In laryngeal 'phthisis, idcerative tonsillitis, ordinary foetid sore-throat, 
a nd even in pulmonary phthisis, a 2 per cent, solution of the pure 
hydrogen peroxide is of service when used in a fine spray atomizer. 



PANCREATIN. 



Under this name a number of firms now sell an extract from the 
pancreatic gland or juice. It contains, or should contain, the four 
pancreatic ferments : trypsin, which digests proteids (meats, eggs, 
etc.); steapsin, which splits up and emulsifies the fats ; amylopsin, 



PAEEIRA. 241 

which has diastatic power — that is, converts starch into sugar ; and 
finally, a milk -curdling ferment. 

A preparation equally as useful as the commercial pancreatin may 
be made by the physician in the following manner : 

Take the pancreas of a pig which has been killed about six hours 
after a full meal, and is therefore active, and after chopping it up 
finely add to it four times its weight of dilute alcohol and allow it 
to stand for twelve hours. Decant or filter off the alcohol and give 
the filtrate iu the dose of 1 to 2 drachms ; or, better still, as follows : 
Wash and chop up finely a fresh pancreas and allow the gland to soak 
in alcohol (absolute) twenty- four to forty-eight hours. After this 
squeeze out the alcohol and add to the gland ten times its weight of 
glycerin. This must stand forty-eight hours and then be filtered 
and used in 30 drop doses to each glass of milk. (See Peptonized 
Foods.) 



PARALDEHYDE. 

Paraldehyde is a form of aldehyde used as a soporific and nervous 
sedative. It possesses the great disadvantages of being given in 
large dose, possessing a disagreeable taste and odor, and being very 
apt to disorder the stomach. It kills in overdose by respiratory fail- 
ure, but is not so depressant to the heart as is chloral. It requires 
frequent repetition and soon loses its power. 

The dose is 20 drops to 1 drachm in capsules, or better still, after 
the formula of Yvon, as follows : 



J& . — Paraldehyde 

Alcoholis (90 per cent 
Tinct. vanillas 
Aq. . . . 

Syrup, simplicis. 



f Z *S. 

q. s. ad. f Jj iv. 



M. — S. A dessertspoonful every half hour until sleep is obtained. 



PAREIRA. 

Pareira, U. 8., Pareirce Radix, B. P., is the root of Chondodendron 
Tomentosum, a plant of Peru and Brazil, and is used as a diuretic 
of an alterative or stimulant character, and in chronic inflammation 
of the genito-urinary type in general. The dose of the unofficinal 
infusion is a wineglassful, and the fluid extract {Extraetum Pareirce 
Fluidum, U. 8.) is given in the dose of a teaspoonful three times 
a day. The B. P. preparations of this drug are the decoction (Be- 
coctum Pareirce), dose 1 to 2 ounces, the extract {Extraetum Pareirce), 
dose 10 to 20 grains, and Extraetum Pareirce Liquidum, dose 1 to 2 
drachms. 

16 



242 DRUGS. 



PEPO. 



Pepo, U. S., Pumpkin Seed, the seed of the ordinary domestic 
pumpkin, is a useful and efficient vermifuge against the tape-worm. 
The seeds are not only efficient, but harmless to the host of the worm. 
The outer coverings of the seeds should be removed and the remain- 
ing part rubbed up into an emulsion with water, or into an electuary 
with sugar, the dose of the seeds being 2 ounces. This should be 
taken on an empty stomach and followed by an active purge. 



PEPPER. 

Piper, U. S. y or black pepper (Piper Nigrum, B. P.), is the unripe 
fruit of Piper Nigrum, & vine of India, Java, Borneo and Siam. It 
contains an alkaloid, Pipeline, wiiich is officinal. 

Therapeutics. — Black Pepper maybe used as a counter-irritant or 
internally as a carminative and stimulant to the alimentary canal. 

It is also used in all cases where atony of the mucous membrane 
of the genito-urinary system is present, but is contra-indicated where- 
ever acute inflammation is present, as in acute gonorrhoea. It may 
be used in great flatulence with marked relief. 

Pipeline has been used as an antiperiodic with varying success, 
and is given in the dose of 1 to 5 grains. The oleoresin (Oleoresina 
Piperis, U. S.) is given in the dose of J to 2 drops in laxative pills, 
to prevent griping. A confection (Confectio Piperis) is officinal in 
the B. P., given in the dose of 1 to 2 drachms. 



PEPPERMINT. 

Mentha Piperita, U. S., is officinal in the form of the leaves and 
tops. It has an aromatic odor and taste. Locally applied the oil 
acts as an irritant and local anaesthetic. 

Therapeutics. — Peppermint is used as a domestic remedy very 
largely for flatulence and infantile colic. Sometimes the oil is added 
to purgative pills to prevent griping, and it may be employed to 
cover the taste of many medicines which are disagreeable to take. 
In this respect it is used as are all the volatile oils. In the colic of 
children of six*months to a year, when it is unusually severe and asso- 
ciated with nervous symptoms, the following will be found of value : 

R. — Chloral ■ . gr. xvj. 

Potas. brom. gr. xxxij. 

Aq. menth. piperit f ^ ij. 

M. — S. Teaspoonful in a little warm water every four hours. 



PERMANGANATE OF POTASSIUM. 243 

When used in neuralgia, oil of peppermint should be placed on a 
piece of linen or muslin rag arid applied over the sore spot. Care 
must be taken that it does not blister the skin. If the burning 
is too severe. after its removal, a little cosmoliue or olive oil should 
be applied. Oil of peppermint is sometimes placed on cotton and 
used iu toothache, but it is to be remembered that the more 
menthol is present in the oil the more active will it be, and that 
the Chinese oil contains more menthol than the American oil. 

Administration. — Peppermint is used in the form of the oil {Oleum 
Menthce Piperita?, U. 8. and B. P.), dose 1 to 4 drops; the spirit 
(Spiritus Menthce Piperitce, U. 8. and B. P.), dose 10 to 30 drops; 
the water (Aqua Menthce Piperitce, U. 8. and B. P.), dose 1 to 2 
drachms, and finally as the Troches (Trochisci Menthce Piperita?, 
U. 8.) to be held in the mouth in indefinite number. Essentia 
Mentha? Piperitce, B. P., is given in the dose of 10 to 20 minims. 



PEPSIN. 

Pepsin, B. P., is the digestive ferment of the stomach. That 
sold in the shops is generally derived from the pig, and is prepared 
by many persons in many ways. Much of the pepsin of the market 
contains more peptone than pepsin, and much mucus and albumen. 
Used with hydrochloric acid in weak solution, it replaces the diges- 
tive action of the stomach. Pepsin containing peptone has the 
peculiar musty smell of peptone, and if the peptone is in excess, 
will absorb moisture and become sticky on exposure to the air. 

Therapeutics. — Pepsin is a much over-rated remedy for indiges- 
tion. Pancreatin will always be found more serviceable, and should 
be given one or two hours after meals. Pepsin should be used at 
once, after the food or with it. The hydrochloric acid should always 
be present, as its presence converts any pepsinogen in the gastric 
tubules into pepsin. Pepsin is officinal in the U. S. P. as Pepsinum 
Saccharatum, dose 20 to 30 grains to be of service, which is a weak 
and almost useless preparation, made up chiefly of milk sugar. 
Liquor Pepsini, U. 8., is given in the dose of 2 drachms. Pure 
pepsin should be given in 5 to 15 grain doses. 



PERMANGANATE OF POTASSIUM.^ 

Potassii Permanganas, U. 8. and B. P., is a salt of a dark, pur- 
plish-red color, appearing in small crystals and readily soluble in 
water. In the presence of moisture it rapidly gives up the oxygen 
which it contains and becomes the binoxide of manganese. 

By reason of this oxidizing power the permanganate of potassium 



244 DRUGS. 

is largely used as an antiseptic and deodorant. It should not be 
employed as a disinfectant, because its action is too fleeting. 

Permanganate of Potassium (Potassii Permanganas, U. S. and 
B. P) is given in the same dose for the same conditions as the 
binoxide of manganese, but is much less efficacious. It is also very 
apt to disorder the stomach and irritate this organ. 

It is thought to be useful in dyspepsia, flatulence, lithcemia and 
obesity, and in the former states is certainly of service, being a 
destroyer of the abnormal products by oxidation. Owing to this or 
other reasons, it has been asserted by Weir Mitchell and Reichert 
to be the most efficient antidote to snake venom, if placed in the wound 
before the poison can be absorbed. Owing to its rapid absorption of 
oxygen it acts as an antiseptic, and may be used in the washing of 
wounds, ulcers and sores, and as a lotion in the form of a gargle, or 
on a swab in diphtheria and scarlet fever. The solution used 
should be from 20 to 60 grains to the pint; the former if used 
on mucous membranes, the latter for sores and wounds. In fwtid 
rhinitis and otitis media permanganate solution is useful. When 
given in solution it should be put with distilled water and should 
never be mixed in a mortar with any organic matter, as it will 
explode. A solution (Liquor Potassii Permanganas) is officinal in 
the B. P. 



PETROLATUM. 

Under the name of Petrolatum, U. S., or Unguentum Petrolei, is 
sold a semi-solid substance derived from coal-tar and sometimes called 
Cosmoline or Vaseline. 

Owing to its soothing powers and non-rancidity, it is used as an 
emollient dressing in sores and general skin affections. It has no 
value except as a protective, and may be given in capsules in cases 
of gastro-intestinal irritation in any quantity as a soothing treatment. 
It does not affect the passages from the bowels and is not absorbed, 
although assertions to the contrary have been made. It is a useful 
vehicle for medicines for the skin. Under the name of fluid or liquid 
cosmoline a fluid form is sold, and used as a spray in rhinitis and 
after irritant applications to the nasal cavities. 



PHENAOETINE, AOETPHENETIDINE. 

This is another one of the coal-tar products introduced several 
years ago as an antipyretic of the same character as antipyrine, and 
while more apt to disintegrate the blood in large amounts than the 
latter drug, is not very dangerous, because its influence upon other 
vital functions is not severe. 



PHENACETINE, ACE TP H ENETI DI NE . 245 

Physiological Action. — Unfortunately our knowledge of the phy- 
siological action of phenacetine upon the nervous system is not as 
thorough as might be desired. We know, however, that it is a dis- 
tinct nervous sedative, and that it acts particularly on the spinal 
cord in its sensory columns. 

Upon the circulation the drug has little or uo effect, unless given 
in doses far above those generally employed, or continued in over- 
dose for some time. The blood after the ingestion of these doses be- 
comes dark and blackish from the formation of methaBmoglobin, and 
the urine becomes after full doses dark-yellow and reacts to Fehling's 
solution. Upon normal bodily heat and the heat of fever the drug 
exerts a depressing effect, decreasing the production and dissipation 
of heat. 

Therapeutics. — Our knowledge concerning the influence of phena- 
cetine upon the human body in disease, may be divided into two sep- 
arate parts, in much the same manner that we divided antipyrine — 
namely, its uses as an antipyretic and as an analgesic. 

Like the other members of the antipyretic group which are blest 
with this double action, its antipyretic influences were first observed, 
and shall therefore be spoken of first. 

The employment of this drug in medicine was first attempted by 
Hinsberg and Kast, Avho at the very start spoke of it in the highest 
terms of praise. They found that it seldom, if ever, caused serious 
untoward effects and that its power over fever in the dose of from 3 to 
8 grains was quite extraordinary. Very shortly after the paper of 
these writers appeared, Kohler published the report of its use in some 
fifty cases in the clinic of Bamberger of Vienna, the febrile affections 
being tuberculosis, pneumonia, typhoid fever, pleurisy and several 
other diseases of like character. He found, as have most of his suc- 
cessors, that the fall of fever does not occur for nearly half an hour 
after the dose is taken, and continues for from four to eight hours 
afterward. 

As a general rule, sweating was not noted as being present to any 
great extent, but in phthisis and advanced typhoid there can be 
no doubt that chilliness and abnormal temperature may come on. 
Cvanosis and vomiting did not occur in a single one of Kohler's 
cases. In a very instructive case of pneumonia due to septic infec- 
tion in a patient of twenty years, phenacetine not only lowered the 
fever, but in addition decreased, to a large extent, the blood in the 
urine, and did not in the slightest degree influence the kidneys un- 
favorably. That the drug has power is evidenced by the fact that 
Kohler used it only when the temperature reached as high as 103°, 
104°, or 105° F., and in these cases the temperature fell not less 
than from three to five degrees. 

It is a very important fact to be remembered that morning doses 
of phenacetin seldom have as powerful an influence as evening doses. 
Two morning doses are only equal to one evening dose in most 



246 DRUGS. 

cases, and it is generally found better in phthisis to give the drug 
about noon to prevent the evening exacerbation of temperature than 
to resort to it at a time nearer the pyrexial period. 

The conclusions of Kohler have been confirmed by Hoppe in a 
long series of studies, and this writer also points out the deleterious 
excess of apyrexia, which sometimes comes on in debilitated cases of 
phthisis. 

One of the advantages of having several drugs belonging to one 
class is the benefit often derived from the use of one where another 
has failed. Thus Huber found that in several instances phenacetine 
was successful where antipyrine had not acted, and believes it to be 
the more powerful drug of the two, a conclusion also reached by 
Heusner, who thinks that 15 grains of phenacetine are equal to half 
as much antifebrin and to 30 grains of antipyrine. Lepine, who has 
done so much with the other antipyretics, also believes it to be 
superior to them all, and in this Guttmann is largely of the same 
opinion. 

These conclusions are, in the author's belief, far too favorable, for 
while he has found the drug to possess powerful antipyretic activity 
and to be useful in nearly all the fevers where antipyrine can be 
employed he does not look upon it with the same degree of confi- 
dence that he does the other drugs, when anxious to reduce a fever 
which seems dangerous and worthy of rapid and certain reduction. 

Upon the nervous system phenacetine acts as an autineuralgic, is 
of service in migraine and ordinary headache from eye-strain, in 
tabes dorsatis, in intercostal neuralgia, and in rheumatism. Some- 
times it cures these troubles when antipyrine fails. Altogether we 
may consider phenacetine a rival of antipyrine as a reliever of pain. 



PHOSPHATE OF SODIUM. 

Sodii Phosphas, U. 8. and B. P., is a preparation rarely, if ever, 
used to supplant phosphorus, aud has an entirely different effect. It 
is particularly useful in bottle-fed children, who continually alternate 
between diarrhoza and constipation, and is also useful in rickets. It 
should be added to each bottle of milk in the dose of 2 to 4 grains. 
It is more laxative than the contrary. 



PHOSPHIDE OF ZINC. 

Zinci Phosphidum, U. S., is- often used in place of phosphorus, 
owing to its greater stability and readiness of prescribing. The dose 
is 2V to tV °f a g ram three times a day. It is used in gelatin- 
coated pills. 



PHOSPHORUS. 247 



PHOSPHORUS. 



Phosphorus, U. S. and B. P., is a non-metallic element generally 
obtained from bones and is very soluble in oils, less so in ether and 
alcohol. Its odor is very characteristic and peculiar. When placed 
in a dark room after exposure to light it is luminous and if exposed 
to the air will ignite. It should be kept in tightly stoppered bottles 
under water. Very commonly it is contaminated by arsenic and 
sulphur. 

Physiological Action. — Phosphorus is found in large amount, 
comparatively speaking, in the bones and in the nervous system, and 
is a stimulant to both. It is, therefore, a direct replacer of nervous 
tissue and a cause of bone-growth. Upon tissue-waste the drug acts 
as a depressant, thereby preserving the body, for it decreases the 
elimination of urea and diminishes the quantity of carbonic oxide 
exhaled. 

Upon the growth of bones phosphorus has a most remarkable 
influence causing, when it is given to young animals, great increase 
in the size of the parts. The first change noted is an enlargement 
which consists in a jelly-like mass containing little or no bone salts, 
and this is finally converted into very hard material which may fill 
the entire canal in the centre of the bone. Kissel has denied this, 
but his results must be doubted in view of the thorough studies of 
Wegner. 

Acute and Chronic Poisoning. — When phosphorus is taken in 
poisonous dose, often from the ends of matches, no symptoms may 
come on for eight or ten hours. At the end of that time the pecu- 
liar taste of phosphorus may be noticed in the mouth, the breath is 
heavily laden with its odor, and burning pain in the oesophagus, 
stomach, and abdomen ensues. Vomiting and purging now assert 
themselves, and both the matters vomited and passed from the bowels 
may be luminous in the dark owing to the presence of phosphorus. 
The vomiting is at first made up of food, then mucus, then bile, then 
perhaps blood. All the symptoms of a mild gastro-enteritis may 
develop, but it is to be noted that constipation of an obstinate type 
may replace the purging. Very soon the liver increases in size and 
gives rise to general hypochondriac pain and tenderness as well as 
local swelling. At the end of twenty-four hours, or, perhaps, after 
the second day, a cessation in the symptoms occurs, and, if the phy- 
sician be not on his guard, will lead him to a hopeful prognosis. In 
the course of a few hours jaundice begins in the conjunctiva and then 
extends over the entire body. With the onset of jaundice the vom- 
iting and pain return with renewed vigor. The matters vomited are 
often the color of " coffee grounds," due to exuded and altered blood. 
The bowels are absolutely confined, or the few hard masses passed 
are white and clay-like because of the absence of biliary coloring 



248 DRUGS. 

matter. There is no bile in the vomit in this stage because the hep- 
atic ducts have been closed by the inflammation set up in the liver. 
After this nervous symptoms ensue. Muscular twitchings, headache, 
vertigo, wild delirium, erotic convulsions, and finally unconsciousness 
and death occur. Sometimes the convulsions occur just before dis- 
solution. Even if the patieut survives the acute stage he generally 
dies of the changes produced in his organism, which consist in wide- 
spread fatty degeneration, even iu the acute stages. Atrophy of the 
liver, destruction of the gastric tubules, pancreatic involvement and 
kidney degenerations aid in producing the ultimately fatal result* 

During the poisoning by phosphorus the urine is scanty and per- 
haps albuminous, and is peculiar because of the unusual substances 
found in it. The most unusual of these is sarco-lactic acid, which 
results from the breaking-down of the muscular tissues. Leucin 
and tyrosin are also found, and tube-casts, with fatty globules in them 
are seen. Free fat globules may also occur. Bile acids and bile 
coloring matter are found in large amount, and the urine is generally 
dark colored for this reason. As phosphorus is eliminated as hypo- 
phosphoric acid this substance is also present. 

The symptoms may so closely resemble those of acute yellow 
atrophy of the liver as to make a differential diagnosis impossible 
unless some evidence of the presence of phosphorus is obtainable. 

In chronic poisoning by phosphorus, when, by the inhalation of 
its fumes systemic changes occur, the most common lesion is necrosis 
of the lower jaw, which may be widespread or limited. It never 
occurs in those who have no solution of continuity in the teeth or 
gums, and for this reason it is necessary that the employees in match 
factories should have their teeth constantly attended to. It is said 
that pans containing turpentine when set around the room will protect 
the workmen, but this is the merest fetich. 

Treatment of Acute Poisoning. — The antidote to phosphorus 
is sulphate of copper, which will act as an emetic if given in excess. 
Oil of turpentine in America is not only valueless, but harmful, for 
it is only old, ozonized, French oil of turpentine, which is antidotal. 
As phosphorus is soluble in oils we simply aid in its absorption if 
any such substances are given. 

Therapeutics. — Owing to its influence on the development of 
bone, phosphorus is very useful in rhaehitis and osteomalacia. It is 
also useful in the sweats of general or nervous debility and in nervous 
exhaustion, and in some cases of melancholia depending upon over- 
work. In the course of prolonged exhausting diseases, as typhoid 
fever or typhoid pneumonia, the drug is of service if the nervous 
system seems to be particularly affected, and in convalescence it is of 
great service to aid in building up the shattered forces of the patients. 

In the sequelae of acute and chronic alcoholism and in morphio- 
mania it is often of service. Phosphorus is also employed in sexual 
exhaustion or abuse. In boils and carbuncles and similar disorders 



PHYSOSTIGMA. 249 

phosphorus is very useful, particularly in acne indurata. Iu pneu- 
monia some physicians use minute doses with the belief that it aids 
in the production of resolution, one of the most enthusiastic of these 
being Dr. Board man Reed. 

In neuralgia from nerve-depression, and in cerebral softening and 
meningitis of a chronic type, phosphorus often does good. 

The dose of phosphorus is yww to ^ of a grain in pill form 
(Pilula Phosphori, U. S. and B. P.), but it may be gradually pushed 
to -^ of a grain if urgently needed. Phosphorated oil {Oleum 
Pkosphoratum, U. S. and B. P.) is given in the dose of 1 to 5 
minims. 

The beginning dose should not be above T ^ of a grain for fear 
of some idiosvncrasy. 



PHYSOSTIGMA. 

Physostigma, U. S., Physostigmatis Semen, B. P., is a seed derived 
from Physostigma Venenosum, a tree of West Africa, often called 
Calabar Bean. It contains two alkaloids, eserine or physostigmine, 
and calabarine. The former is the most important, from a medical 
point of view. 

Physiological Action. — Calabar bean is a general paralyzant, but 
if the calabarine be in excess it may be a convulsant. 

Nervous System. — On the spinal cord, in poisonous dose, this 
drug acts as a direct depressant poison, particularly affecting the 
motor tracts. On the motor nerves it exerts no influence at all, or 
in large toxic doses depresses the peripheral ends of the motor nerves. 
The sensory nerves generally escape, but sometimes even they are 
involved. On the voluntary muscles the drug in these doses causes 
twitchings, due to a direct influence over their fibres. In all medi- 
cinal doses the drug is a stimulant to unstriped muscular fibre. 

Circulation. — Calabar bean causes comparatively little circu- 
latory change, but it causes a rise of arterial pressure, based largely 
upon a direct stimulation of the heart, and slows the pulse by stimu- 
lation of the cardiac inhibitory nerves peripheral ly. 

Respiration. — In moderate amount Calabar bean causes no in- 
terference with the respiration, but in poisonous close produces death 
by paralysis of the respiratory centre. 

Pupil. — Physostigma causes myosis or contraction of the pupil 
by stimulation of the oculo-motor nerves peripherally, and by de- 
pression of the sympathetic fibres. It decreases intra-ocular tension. 

Physostigma is a stimulant to intestinal peristalsis, increasing the 
muscular activity in the walls of the gut, and acting as a tonic to 
these fibres. 

Poisoning. — Calabar bean is used by the Africans as an " ordeal 



250 DRUGS. 

bean," to determine whether a person is guilty or not of a crime. If 
an individual eats it and survives he is guiltless, but if he dies he is 
guilty, according to this rather fatalistic belief. If he does survive 
it is generally by reason of the calabarine producing vomiting and 
purging, and so ridding the stomach of the poison before it is 
absorbed. 

Poisonous doses cause muscular tremors, followed by complete 
muscular relaxation. The pupils contract, the respirations become 
slow and irregular, and all reflex action fails. Vomiting or purging 
may or may not occur. 

Treatment of Poisoning. — This consists in the use of atropine, 
which is the physiological antidote, in the employment of heat to the 
body, and the use of respiratory and cardiac stimulants. 

Therapeutics. — Calabar bean is employed in many affections, such 
as trismus neonatorum, tetanus, and other spasms, with only moderately 
good results. It is, however, of value in atony of the bladder and 
intestines, and in catarrh of the bowels. The author has used it 
with great success in gastric and intestinal dilatation. 

In bronchial asthma and emphysema it will aid in the expulsion of 
the mucus by its influence over the muscular fibres in the walls of 
the tubes. It is also useful in purgative pills. (See Constipation.) 

Administration. — Physostigma is used in the form of the extract 
(Extractum Physostigmatis, U. 8. and B. P.) in the dose of -J of a 
grain, which may be readily increased to J of a grain. 

The tincture (Tinctura Physostigmatis, U. S.) is given in the dose 
of 10 to 40 drops. 

Eserine (Physostigmina, B. P.) may be used in the dose of -^ of 
a grain three times a day. In the eye, in the strength of 1 to 2 
grains to the ounce of water, eserine is used in iritis to break up 
bands, and in corneal ulcerations, and for the relief of glaucomatous 
states with high intra-ocular tension. If, for any reason, atropine 
mydriasis is to be overcome rapidly, eserine is to be used, but it is 
not so powerful as atropine, and it will require larger amounts of 
the solution to produce contraction than it took of atropine to cause 
mydriasis. Lamellce Physostigminw, B. P., each contain 10 1 00 of a 
grain of physostigmine. 

PITCH. 

Pix is a resinous exudation derived from several species of pines, 
firs, and spruces, and is, in one of its forms, obtained by the evapora- 
tion of wood-tar. It is used for various purposes, according to its 
derivation. Burgundy Pitch {Pix Burgundica, U. S. and B. P.) 
is derived from Norway spruce or Abies Excelsa, a plant of Europe 
and Asia. It softens and melts at the temperature of the body, and 
is useful in plasters. In muscular rheumatism and in chronic bron- 



PITCH. 251 

chitiSj it is a mild and fairly useful local remedy. In the form of 
the plaster (Emplastrum Picis Burgundicw, U: S. and B. P.) and in 
the form of warming plaster (Emplastrum Picis cum Cantharide, U. 
S.), it is employed for deep-seated sprains and bruises as a mild 
counter-irritant, which may blister tender skins. Canada pitch (Pix 
Canadensis, U. 8. and B. P.) is obtained from the hemlock spruce 
of Canada and the United States, and is used for the same purposes as 
Burgundy pitch. The plaster (Emplastrum Picis Canadensis, U.S.) 
is employed for the same conditions as the plaster of Burgundy 
pitch. Under the name of Pix Liquida, U. S. and B. P., or Tar, 
we have an empyreumatic oleoresin obtained by destructive dis- 
tillation from Pinus Palustrus and other varieties of pine. It is 
a thick, dark oil, slightly soluble in water, and soluble in alcohol, 
oils, and solutions of potassa and soda. By distillation from this 
we obtain oil of tar (Oleum Pieis Liquidoe, U. S.), which is some- 
times used by inhalations from an atomizer in bronchitis, but is 
not a particularly useful application. It should be diluted with 
some other oil or fluid cosmoline. Tar is used in sub-acute and 
chronic bronchitis in 2-grain pills, aud as a remedy in gastro- 
intestincd eatarrh. Externally, it is used in psoriasis and other skin 
diseases needing stimulation. In obstinate diarrhoea Wood has highly 
recommended a mixture of tar made as follows : Add a pint of tar 
to a gallon of lime-water, and allow this solution to stand one week, 
stirring it every few hours. Decant the clear liquid and percolate it 
through powdered wild-cherry bark, allowing one ounce of the bark 
to be present for each pint passed through it. The dose is a wine- 
glassful. 

In chronic bronchitis tar- water is largely used, as a popular remedy, 
in Europe and England. Tar-water is made by shaking 1 part of 
tar with 4 parts of water several times during twenty-four hours, de- 
canting and filtering. The dose is from 1 to 2 pints a day as a 
drink. It at first increases the expectoration but finally decreases it. 

Syrup of tar (Syrupus Picis Liquidce, U. S.) is simply sweetened 
tar-water. 

In sl:in diseases of the dry, scaly sort tar ointment (Unguent urn 
Picis Liquidce, U. S. and B. P.), equal parts of tar and suet, is very 
useful if frequently applied. It should not be used on the face as it 
will stain the skin. 

Wine of tar ( Vinum Picis) is made by adding together tar 1 pint, 
glycerin, white wine, and honey, half a pint of each, dilute acetic 
acid 1 ounce, and 3 quarts of boiling water, and shaking constantly 
at a temperature of 160° Fahr. for several hours. It is then set 
aside to stand for some days and repeatedly filtered or strained 
through muslin. The dose is 1 to 4 ounces. It may be used instead 
of tar-water or tar syrup. 



252 DRUGS. 



PODOPHYLLUM. 

Podophyllum, U. S., PodophyUi Bhizoma, B. P., May Apple or 
Mandrake, is the rhizome and small roots of Podophyllum Beltatum, 
a plant of the United States and Canada. Podophyllum contains 
a resin podophyllin. 

Therapeutics. — Podophyllum is the slowest acting purge in the 
pharmacopoeia. In small doses it is laxative, but is purgative and 
almost drastic in larger doses. In overdose it may produce gastro- 
enteritis. The drug particularly excites the flow of bile and is used 
as a cholagogue. It is best when the stools are dark in color, calomel 
being indicated when they are light. In children one or two months 
old who have hard stony stools podophyllin is the best remedy. The 
dose should be given by dissolving a grain of the resin in a drachm 
of alcohol and using 2 drops of this on sugar once or twice a day. 
In children who suffer from diarrhoea in which the passages consist 
almost entirely of water, and the passages have a peculiar musty smell 
or mouse odor podophyllin in the dose of -^ to -^ of a grain is of 
service, seeming to control the passages and make them normal. This 
treatment will often succeed when all else fails, and this holds true in 
the chronic diarrhoeas of adults, though the drug should be given in 
somewhat larger amounts in such cases. It will also check vomiting 
in these doses in some instances. 

Administration. — Podophyllum is used in the form of the extract 
(Extr actum PodophyUi, U. S.), dose 5 to 10 grains, as the abstract (^46- 
stractum PodophyUi TJ. S.), dose J to 1 grain, the fluid extract (JEx- 
tr actum PodophyUi Fluidum, U. S.), dose 2 to 20 drops, and more 
commonly than all as the Besina PodophyUi, U. S. and B. P., or 
Podophyllin, which is the best preparation. The dose of this is 
from 2V to ^ of a grain as a laxative, and from -^ to J a grain as 
a purge. The tincture of the resin (Tinctura PodophyUi, B. P.) is 
given in the dose of 15 minims to 1 drachm. 



PRUNUS VIRGINIANA. 

Primus Virginiana, U.S., Wild Cherry as it is incorrectly called, is 
the bark of Prunus Serotina, a large tree of the United States and 
Canada. It contains two substances known as emulsin and amyg- 
dalin, which when they come together in water form hydrocyanic acid. 

Therapeutics. — Wild cherry bark is largely used as a domestic 
tonic, and in the form of a syrup as a vehicle for cough mixtures. 

It has been supposed that the hydrocyanic acid present allays the 
cough, but this is doubtful, as the acid is very fleeting in its effect and 
present in very small quantity. 



QUERCUS ALBA. 253 

Administration. — As a tonic it is used in the form of the infusion 
(Infusum Pruni Virginians, U. S), dose J to 1 ounce, and the fluid 
extract (Extr actum Pruni Virginiance Fluidum, U.S.), dose 30 drops 
to 1 drachm. The syrup (Syrupus Pruni Virginiance, II. 8.) is 
given in the dose of 1 to 4 drachms. 



QUASSIA. 

Quassia, U. S., Quassia? Lignum, B. P., is the wood of Picrama 
Excelsa, a large tree of Jamaica and other islands of the West Indian 
group. It contains an active principle named quassin, which is 
intensely bitter and irritant to mucous membranes. Quassia is a 
simple bitter tonic, which has been used very largely in domestic 
medicine and by the medical profession. It is very efficient, and is 
supposed to be particularly useful in the anorexia following malarial 
fevers, and has even been thought to possess antiperiodic power. 
In simple dyspepsia with eructations after meals, not due to gastritis, 
it is very serviceable. 

In seat-worms (Oxyuris Vermicularis) or thread-worms, as they are 
often called, injections of the infusion of quassia are the most effica- 
cious and useful remedial measures we possess, as well as being very 
harmless. The bowel should be well washed out by soap and water 
and a half-pint of an infusion, made by adding 1 or 2 ounces of 
quassia chips to a pint of water, be injected and retained for some 
minutes. A few such injections will invariably kill the parasites, 
provided the bowel is first well washed out with soap and water. 

Administration. — The tincture (Tinctura Quassia 3 , U.S. and P.P.) 
is given in the dose of J a drachm to 1 drachm, the fluid extract 
(Extractum Quassia? Fluidum, U. S.) J a drachm, and the extract 
[Extr actum Quassia?, U. S. and B. P.) 1 to 3 grains. The infusion 
[Infusum Quassia?, B. P.) is given in the dose of J to 2 ounces, and is 
made by macerating 1 drachm of quassia with 10 ounces of water, 
and allowing it to stand twenty-four hours or more. 



QUERCUS ALBA. 

Quercus Alba, U S. or White Oak in infusion is used as an astrin- 
gent injection in gonorrhoea and vaginitis in the female, where a large 
amount of fluid is necessarily employed. It is also used in prolapse 
of the rectum, in haemorrhoids, in leucorrhwa and as a gargle in sore- 
throat. It stains the clothing very slightly. 

Quercus Tinctoria is equally efficient, but is seldom used because it 
stains the clothes very badly. Either may be used in infusion of 
the strength of one ounce to the pint. In the form of the pow- 



254 DRUGS. 

dered bark it is often used as an astringent poultice to freely running 
sores to check the discharge. Decoctum Quercus is officiual in the 
B. P. 

RESIN OR ROSIN, 

Itesina, U. S. and B. P., is Kesin or Rosin, the mass left after the 
distillation of turpentine, and enters largely into plasters, cerates, and 
similar preparations. Its burning fumes when inhaled are said to 
be of value in cases of chronic bronchitis. Oeratum Resinw, U. S., is 
used in chilblains and superficial scalds, and Emplastrum Resinw, 
U. S. and B. P., is adhesive plaster. Unguentum Resince is a B. P. 
preparation used for the same purposes as the plaster or cerate. 



RESORCIN. 

Resorcin is the meta compound of the group of which hydro- 
chinone is the para and pyrocatechin the ortho, and occurs in clear 
crystals of a slightly reddish hue. It .is quite soluble in water, 
alcohol, and ether. 

Physiological Action. — Resorcin is an irritant to mucous mem- 
branes, and when taken internally in poisonous doses causes deafness, 
giddiness, salivation, profuse sweat, unconciousness, and clonic con- 
vulsions. The heart is at first slowed by vagal stimulation, then 
becomes very rapid from vagal palsy. 

Therapeutics. — Resorcin has been found of service as a remedy 
for tchoojoing-cough, given in the dose of 10 drops of a 2 per cent, 
solution, or used iu a spray of the same strength, which is the better 
method of the two. 

Resorcin has also been employed in a spray in a 20 per cent, solution 
in hay-fever with remarkably good effects. It has been used as an 
antipyretic, but is not serviceable, and has feeble power against strong 
fevers. 

The chief use of resorcin is in skin affections of a sub-acute or 
chronic character, such as eczema, with much induration, and in psor- 
iasis. In these states an ointment of the following character, well 
applied, is of service. 

R.— Kesorcin • 33- 

Zinci oxidi . . gj. 

Ung. aquae rosse ....... gx. 

M. — S. Apply to the part. 

RHUBARB. 

Rheum, U. S., Rheum Radix, B. P., is the root of Rheum offici- 
nale, a plant of Thibet, but which is cultivated in America and else- 



RHUS AROMATICA. 255 

where. It is also derived from China, and this variety is known 
as Chinese Rhubarb. Several alkaloids are contained in it, all of 
which are unimportant and never used alone, except chrysophanic 
acid. 

Physiological Action. — According to the studies of Prevost and 
Binet, rhubarb acts inconstantly upon the flow of bile, sometimes 
increasing it, sometimes having no effect, but according to those of 
Rutherford and Yignal it never fails to stimulate biliary secretion. 
Owing to the astringent properties possessed by rhubarb it does not act 
excessively, and improves the appetite, digestion and intestinal tone. 

Therapeutics — Whenever it is desired simply to unload the bowels 
without affecting the general system, rhubarb may be employed. In 
other words, it is useful in simple constipation. In children a state 
is very commonly seen in which constipation will be replaced by 
diarrhoea if any ordinary laxative is employed, and in these instances 
rhubarb is the best remedy, as it is astringent and prevents any after- 
effects beyond those produced by the dose. In the summer diarrhoea 
of children, where the stools are green, rhubarb is often used to 
empty the bowels of fermentative products before direct treatment is 
instituted. 

Administration. — The preparations of rhubarb are very numerous 
indeed. Rhubarb itself may be given in the dose of 20 grains of 
powder and small pieces of the root are habitually chewed for con- 
stipation. Extr actum Rhei, U. 8. and B. P., is given in the dose of 
5 to 10 grains in pills ; Pilulce Rhei, U. 8., each contain 3 grains 
of rhubarb; Pilulos Rhei Oompositus, U. 8. and B. P., contain 
2 grains of rhubarb and If of aloes and are given in the dose of 2 
or 3 pills. Pidvis Rhei Coinpositus, U. 8. and B. P., contains mag- 
nesium, dose 20 to 40 grains ; Extractum Rhei Fluidum, U. 8., is 
given in the dose of 20 to 30 minims. Syrupus Rhei, U. 8. and 
B. P., is given in the dose of one drachm to a babe, 4 drachms to 
an adult, although rarely used for such persons. Syrupus Rhei 
Aromaticus, U. 8., is given in the same dose and to the same class 
of cases. Tinctura Rhei, U. 8. and B. P., is used in the dose of ] to 
2 drachms, and Vinum Rhei, U. 8. and B. P., in the dose of 1 to 4 
drachms. Tinctura Rhei Aromatica, U. 8., is used in the dose of J to 
1 drachm and Tinctura Rhei Didcis, U. 8., 2 to 3 drachms. 

The aromatic syrup is commonly employed for children and the 
compound pills for adults. Infusum Rhei, B. P., is given in the 
dose of 1 to 2 ounces, and Mistura Rhei et Sodai, U. 8., in the dose 
of 2 drachms to 3 ounces. 



RHUS AROMATICA. 

Sweet Sumac is unofncinal, but has been so largely used of late that 
it deserves notice. In hoematuria, menorrhagia, diabetes insipidus, 



256 DRUGS. 

and urinary incontinence in children it has been highly praised. In 
the latter affection a sufficient amount of experience has been ac- 
quired to show that it really is of benefit. (Mueller and Unna.) 
Rhus Aromatica should be used in the form of fluid extract derived 
from the bark of the roots according to the general directions in the 
Pharmacopoeia for making fluid extracts. The dose as a remedy for 
urinary incontinence is 15 drops of this preparation. Adults may 
take 15 to 60 drops. The drug is best given in glycerin and water. 



RHUS GLABRA. 

Rhus Glabra, U. 8., smooth sumac, is the fruit of Rhus Glabra, 
and contains tannic and malic acids as its chief constituents of medi- 
cinal value. In the fluid extract (Extraction Rhus Glabrae Fluidum, 
U. 8.) we have an officinal preparation which is very efficient as a 
gargle for sore-throat when diluted with glycerin and water or pre- 
pared according to the formulae given under Chlorate of Potassium. 



ROCHELLE SALTS. 

Sodii et Potassii Tartras, U. 8., 8oda Tartar ata, B. P., has been 
used as a saline cathartic in the dose of ^ an ounce, but is almost 
never used alone. It is the purgative constituent of seidlitz powder. 



ROSA CENTIFOLIA. 

Rosa Centifolia, U. 8., Rosce Centifollce Petala, B. P., Pale Rose, 
possesses almost no medicinal value, but is mentioned because its 
officinal preparations are largely used in practice. 

Aqua Rosce, U. 8. and B. P., is used as a diluent or solvent for 
preparations, such as astringents, which are to be used locally, as in 
gonorrhoea. It may also be used internally for these purposes. Un- 
guentum Aqua Rosce, U. 8., is "cold cream, " and is largely used as 
an emollient application to small burns, sores, cuts, and scratches and 
on chapped, hands and lips. It is much improved if a little glycerin 
and benzoic acid are added to keep it sweet in warm weather. 



ROSA GALLIOA. 

Rosa Gallica, U. 8., Rosce Gallicce Petala, B. P., Red Rose, con- 
tains more gallic and tannic acids than pale rose and is astringent. 



SACCHARIN. 257 

From it are prepared the Extr actum Bosce Fluidum, U. &., dose 5 
drops to 2 drachms, used to flavor other extracts, the Confectio Rosm, 
II. S. and B. P., used as a basis for pills ; Mel Rosce, II. S., or houey 
of rose, for local application or a vehicle for gargles, and the Syrupus 
Rosce, II. S. and B. P., dose 1 to 2 drachms, as a flavoring substance. 
The acid infusion (Infusum Rosce Acidum, B. P.) is given in the 
dose of 1 to 2 ounces. 



RUBUS IDiEUS OR RASPBERRY. 

Rubus Idceus, II. S., or Raspberry, is used for the preparation of 
a syrup (Syrupus Rubi Idcei, II. S.) which is employed very largely 
as an elegant vehicle or flavoring mixture. The leaves are often 
used as a decoction or infusion in diarrhoeas where an astringent is 
needed by housewives in domestic medicine. 



RUE. 

Ruta Graveolens is the source from which we derive the oil of Rue 
(Oleum Rutce, II. 8. and B. P.). 

Physiological Action. — Locally applied rue is an irritant, produc- 
ing vesication, and if taken internally gastro-enteritis, which may be 
most severe. It is eliminated by the lungs, kidneys, and skin, and 
its odor is easily noticed in all these secretions. If the dose be 
poisonous, vomiting, great pain in the belly, and epileptiform con- 
vulsions come on, but death has rarely occurred. 

Therapeutics. — Rue has been used as an abortifacient, but with 
great danger to the mother. Its action is most uncertain even when 
poisonous doses are used. It has been employed in colic as a car- 
minative and seems to be really valuable in atonic Menorrhagia and 
metrorrhagia. 

Given in capsule it has been employed for lumbricoid ov round- 
worms, but ought not to be so used. The dose is 3 to 6 drops. 



SACCHARIN. 

Saccharin is a compound first prepared by Fahlberg under the 
direction of Professor Remsen, of Johns Hopkins University, and 
further studied by him in the Chemical Laboratory of the University 
of Pennsylvania. It is a remarkably sweet substance 220 times 
stronger than sugar in sweetening power, and is used largely to 
sweeten glucose and in confections. It escapes from the body un- 

17 



258 DRUGS. 

changed, has no physiological action, and may, therefore, be used in 
diabetes and gout to sweeten coffee, food, or medicine. The dose is 
indefinite, but it is to be noted that a very few grains will sweeten 
a very large bulk of material. 



SALICYLATE OF MERCURY. 

Salicylate of Mercury is a drug which has come into quite general 
use since the introduction of the hypodermic method of administer- 
ing mercury in syphilis. It is to be suspended in paraffin oil in the 
proportion of 22 grains of the salicylate of mercury to 3 drachms of 
the oil, and before it is used the bottle must be well shaken in order 
that the insoluble mercury may not remain at the bottom. It is of 
great importance that the needle and syringe shall be thoroughly 
cleansed after each injection, as the insoluble drug readily clogs the 
opening of the instrument. At first one minim of the mixture just 
named should be injected deeply into the gluteal region every fourth 
day, and this may be increased to every second day if no systemic 
evidences of the action of the drug appear. 



SALICYLIC ACID. 

Salicylic Acid (Acidum Salicylicum, U. S. and B. P.) is derived 
from carbolic acid by treating it with caustic soda and carbonic acid 
at a moderate heat. It is soluble in 300 parts of water and 4 parts 
of alcohol. 

Physiological Action. — To mucous membranes salicylic acid acts 
as an irritant. (See Poisoning.) 

Nervous System. — Upon the nervous system salicylic acid exerts 
comparatively slight effects in medicinal doses, causing buzzing in 
the ears, decrease of the reflexes, and finally in overdose epileptiform 
convulsions by an action on the brain. 

Circulation. — Upon the circulation the effects of salicylic acid 
are not very marked in medicinal dose. It undoubtedly has a 
depressant rather than a stimulant effect, but the depression is very 
slight. It is sufficient, however, to make the use of the drug in cases 
of feeble circulation worthy of thought and care. 

Kespiration. — Salicylic acid stimulates the pulmonary vagi and 
respiratory centre, but if the dose be poisonous death is due to 
respiratory failure. 

Temperature. — The effect of salicylic acid on temperature has 
been studied by the author with a good deal of care. The drug 
acts as a distinct antipyretic upon fevered states and is a slight de- 
pressant of normal bodily heat. The conclusions of Gedl, Fiir- 



SALICYLIC ACID. 259 

bringer and See also show this, and those of Danewsky point to it. 
In the experiments of North upon man after and during exercise 
the effects were marked. According to the author's studies, the drug 
lowers fever by diminishing heat-production and increasing heat- 
dissipation, but this is by no means positively decided. 

Absorption and Elimination. — Salicylic acid is absorbed from 
the stomach as a salicylate of sodium and so circulates in the blood. 
It is eliminated by the kidneys, and by all the secretions. In the 
urine it appears as salicyluric acid. The urine after large doses is 
dark olive-green, and the change in color is due to the presence of 
indican and pyrocatechin, which are formed by the action of the 
pancreatic juices upon the drug in the intestine. The presence of 
salicylic acid in the urine is to be discovered by the addition of a 
solution of the chloride of iron to the fluid which causes the appear- 
ance of a violet color. 

Poisoning. — Salicylic acid when taken in excessive dose causes 
profuse sweating, roaring in the ears, dimness of vision, headache, 
partial or total deafness, and a decided fall in temperature. The 
pulse becomes weak and relaxed, and finally ptosis, strabismus, and 
general paralysis ensue. The urine and faeces are passed involun- 
tarily, the urine being olive-green. The respirations at first are 
quickened and deepened, but finally become shallow and feeble, 
death ensuing from respiratory failure. 

If the dose is sufficiently large the blood is involved and the cor- 
puscles rapidly break down. 

Therapeutics. — Salicylic acid, owing to its close resemblance to 
quinine, was first introduced as an antiperiodic and antipyretic, but 
soon was found to be of inferior value in these states and of superla- 
tive value in rheumatism. At present, it is never used for either of 
the former purposes, but is largely employed as a standard remedy for 
the latter trouble. 

The value of salicylic acid in rheumatism limits itself solely to 
the relief of pain and the cure of the malady without preventing 
the complications incident to its course. That is to say, the changes 
in the joints or heart are only of less frequency, because the drug 
shortens the disease, and not because it prevents these changes by a 
direct influence ; this is also seen in rheumatic hyperpyrexia, where 
salicylic acid is of service, but often fails to control the temperature to 
any great extent. In acute rheumatism 10 to 15 grains should be given 
hourly, or every two hours, until marked physiological symptoms 
occur. It is to be remembered that in many cases the salicylates are 
of no value whatever, merely producing sweats and headaches, and 
it is also worthy of note that nothing else does these cases much 
good, as they seem bound to run a given course before the patient 
recovers. If a cure does take place relapses are very common indeed, 
and the drug should be continued for several days after all symp- 
toms cease. In gonorrhoea!, rheumatism the drug is of little value 



260 DRUGS. 

until the gonorrhoea is cured, when the rheumatism also ceases, 
whether we give salicylates or not. In rheumatoid arthritis it is 
entirely valueless, and the same statement is true in regard to gout. 
In chronic rheumatism citrate of potassium and sodium may be used 
in place of the salicylic acid, in the dose of 30 to 60 grains, and 
these salts are to be taken just before going to bed. In lumbago, 
sciatica, and similar states, salicylic acid is a very useful remedy. 
While it is not as good as antipyrine in neuralgia, it is of great ser- 
vice in the migraine of rheumatic persons, often entirely curing the 
disease. 

In quinsy or true tonsillitis the drug is a specific, particularly when 
rheumatism is the cause. It will generally prevent suppuration, 
shorten the attack, and relieve the pain and swelling. The doses 
should be small, and given hourly, say 3 grains. In stomatitis, after 
the blisters have broken, the burning and pain are often intense, and 
a mouth wash of salicylic acid in the proportion of 1 to 250 or 
water is useful. 

Ringer recommends the use of the following salve in pruritus ot 
the anus and vulva. 

R> — Acid, salicylic gij. 

01. theobromre . . . . . % v. 

Cetacese . . . . ■. . . 3 i i j . 

01. myristiese ....... igiss. 

In the treatment of corns there is probably no better application 
than lint soaked in a solution of salicylic acid or the use of the fol- 
lowing formula: — 

R. — Acid, salicylic. ....... gr. xxx. 

Ext. Cannabis Indicse ...... gr. v. 

Collodion . . . . . . . . f^ss. 

S. Apply with a brush until a good coat is present. 

A solution of salicylate of sodium or of bicarbonate of sodium ? 
applied on lint to inflamed rheumatic joints, often gives great relief. 

In gastric dilatation or catarrh, where vomiting occurs, and the 
matters vomited contain sarcince, salicylic acid will be found of ser- 
vice, and Bartholow thinks it of value in paroxysmal gastralgia. In 
cases suffering from asccwis lumbricoides or round worms, it may be 
used in the dose of 8 grains every hour till 40 grains are used. 
For thread or seat worms the following injection will be found of 
service : — • 

R. — Acid, salicylic. . . . . . . gs?. 

Sodii biborat. £ss. 

Aquas Oj. 

M. — S. Warm and inject into the bowels. For a child reduce this one-half 
in all its parts. 



SALICYLIC ACID. 261 

In bromidrosis of the feet (excessive sweating with fetor) salicylic 
acid may be dusted over the parts, or the following powder used : — 

R. — Acid salicylic. ") .. Zo 

. i i" > ..... H£l X SS. 

Amy], pulv. J ° 

M.— S. Apply to the feet. 

Iu eczema of the face and hands, where the eczema is of the wet 
or weepiug variety, salicylic acid, locally applied, is of great service. 

Antiseptic Use. — Salicylic acid is employed as an antiseptic in the 
treatment of wounds, as a local remedy and as a dressing, but should 
not be applied over too large an area, as it may be absorbed, and 
produce constitutional symptoms. As an application to small burns, 
a mixture of 1 drachm of salicylic acid to 8 ounces of olive oil is of 
service. Salicylic acid may be added to urine to keep it sweet, but 
will sometimes cause the tests for sugar to appear. Patients taking 
salicylic acid often notice that the urine is odorless after standing, 
and that it will remain fresh for many days. 

Untoward Effects. — Salicylic acid as already stated may produce 
headache and roaring in the ears. In persons with middle ear dis- 
ease it is contraindicated unless urgently called for, as it often 
makes the deafness permanently worse. Sometimes erythema or acne 
follows its employment, and blindness and retinal haemorrhages have 
been found. It would be impossible to enumerate all the untoward 
effects which have been noted, but it is worthy of remark that very 
few deaths have occurred. 1 

Administration. — Salicylic acid has a nauseous, disagreeable taste 
and is irritant to the stomach. It should be given in a solutiou of 
glycerin and water, or its taste may be covered by the use of syrup 
of bitter orange-peel or syrup of ginger. The following formulae 
may be used : 

R . — Acid, salicylic. ..... 

Tine, lavandulae comp. 

Glvcerinaa ..... 

Aquse 

M. — S. A tnblespoonful every 2 hours, or 





J5»- 




fziv. 




f^ss. 


q.s. 


f 3viij 




^ss. 




f ^ ss. 




f|iv. 


q. s. 


f 3 vii j 



R. — Acid, salicylic 

Glyceriuse ...... 

Syrup, aurantii cort. 

Aquse. ....... 

M. — S. A tablespoonful every 2 hours. 

Salicylic acid may be used in pill or capsule, but is irritant to the 
stomach in so concentrated a form ; it must be taken with much 
water, and should follow rather than precede meals. Salicylic acid 
ointment (Unguentum Acidi Salicylici, B. P.) is a useful preparation 
for external application in chronic deep-seated skin diseases. 

1 See my essay on Antipyretics. 



262 DRUGS. 



Salicylate of Sodium. 

Salicylate of Sodium (Sodii Salicylas, U. S. and B. P.) is used as a 
less irritant and somewhat less disagreeable preparation than salicylic 
acid. Its action, doses, and use are the same as the acid. 

Other salicylates are largely used by some persons. Salicylate of 
Lithium is supposed by some physicians to be of more value than 
the other salts. 

If buzzing in the ears is annoying, bromide of sodium in the dose 
of 20 grains will generally give relief. 



SALOL. 

Salol is a mixture of 60 parts of salicylic acid and 40 of carbolic 
acid, and is decomposed by the pancreatic juice into these two sub- 
stances. For this reason overdoses will give symptoms of carbolic 
acid poisoning. Thus 20 grains five times a day, will cause a man to 
take 40 grains of carbolic acid, which is almost a poisonous dose. 

Salol is used for the same purposes as salicylic acid, when the stom- 
ach is irritated and cannot bear the latter drug, as it is dissolved in 
the gut. The dose often used is 10 grains an hour, but this is too 
much and may produce dangerous symptoms. It may be given in 
wafers, capsules, or compressed pills. It is said to be of value in 
duodenal catarrh and catarrhal jaundice. 



'SANDALWOOD. 

Sandalwood (Santalum Rubrum, U. S.), or Red Saunders, is the 
wood of the Pterocarpus Santalinus, a tree of India and the Sand- 
wich and Feejee Islands. It is known under the name of Pterocarpi 
Lignum in the B. P. From it is derived an oil {Oleum Santali, 
U. S. and B. P.) which has a hot, burning taste. The odor is very 
pleasant and it has been used as a perfume. In overdose it is 
capable of producing great irritation of the genito-urinary passages. 

Therapeutics. — The oil of sandalwood, often called erroneously 
the u oil of yellow sandalwood " is much used by genito-urinary sur- 
geons in chronic gonorrhoea and gleet for the purpose of stimulating 
depraved mucous membranes and in chronic cystitis to act as a tonic 
to the bladder. 

In the subacute or later stages of bronchitis, when the expectora- 
tion is thick and ropy and the cold is not readily " thrown off, " the 
oil of sandalwood is a most efficacious remedy. In all cases it should 
be given in capsules in the dose of 5 to 20 drops, 5 drops being gen- 



SANTONIN, OR SANTONINIC ACID. 263 

erally sufficient. It may irritate the stomach but it is not so apt to 
do so as cubebs or copaiba. 



SANGUINARIA. 

Sanguinaria, U. S., or Blood Root, is the rhizome of Sanguinaria 
Canadensis, and has been largely used in medicine, but is a dangerous 
remedy, possessing more power for harm than good. Its chief 
alkaloid is sanguinarine. 

Poisoning. — Sanguinarine in poisonous dose causes vomiting, 
purging, profuse salivation, and finally clonic convulsions which are 
spinal in origin. Death is due to respiratory failure, but the circula- 
tion is much decreased in force and frequency. 

Therapeutics. — The employment of sanguinaria in chronic bron- 
chitis is about the only purpose for which it is now employed to any 
extent. As an emetic in croup it has been largely used but is too 
irritant and depressant and ought not to be so employed. According 
to Bartholow, the drug acts as an hepatic stimulant and is of service 
in g astro-intestinal catarrh with jaundice. 

Administration. — The dose of the fluid extract (Extr actum San- 
guinariw Fluidum, U. 8.) is 1 to 5 drops as an expectorant, or 10 
to 30 drops as an emetic. If it does not act in emetic dose it must 
not be allowed to remain in the stomach. The tincture {Tinctura 
Sanguinaria^, U. S.) is the best preparation for use, and may be 
given in 20 to 30 drop doses as an expectorant, and 1 to 3 drachms 
as an emetic. The vinegar (Acetum Sanguinarice, U. S.) is given 
in the dose of 10 to 30 drops, and as an emetic in the dose of 2 to 4 
drachms. 



SANTONIN, OR SANTONINIC ACID. 

Santoninum, U. S. and B. P., is an alkaloid derived from Levant 
worm-seed or Santonica, which is the unexpanded flower-heads of 
Artemisia Maritima, a plant of Asia Minor and Turkestan. San- 
tonin is soluble in alcohol and chloroform, but less so in water. 

Poisoning. — Santonin causes muscular tremors, convulsive move- 
ments, unconsciousness, and sometimes epileptiform convulsions. 

One of the most common symptoms of the poisoning is chromat- 
opsia or xanthopsia, during which all objects look yellow. This is 
due to the staining of the humors of the eye by the drug. It may 
go on to total blindness, or pass away in a few days. If the color 
is not yellow, it may be green. The urine is also stained; first 
yellow, then saffron, and, finally, purple-red, or is bloody looking. 



26± DRUGS. 

This is not due to the presence of blood, but to the drug. Poison- 
ous doses of the drug do not cause gastro-enteritis. 

Therapeutics. — Santonin is used for the treatment of round-worm, 
and is very efficacious. It has no influence on the tape-worm. It 
should be given in the manner of all vermifuges (see Worms), 
namely, at a time when the stomach is empty. Santonin is said to 
have a distinct influence over vision, increasing, in medicinal amount, 
its acuity whenever the optic nerve is at fault. In urinary inconti- 
nence santonin will often produce cure after all other remedies fail. 

Santoninate of Sodium (Sodii Santoninas, U. S.) is a useless, harm- 
ful preparation, never to be employed except for the benefit of the 
eye when vision fails through disease of the optic nerve. Introduced 
into medicine because of its solubility, it does just what is least 
desired in treating worms, namely, is absorbed into the system, 
leaving the worm in peace in its resting-place. In eye affections the 
dose may be from 2 to 8 grains, according to the age of the adult. 

Santonin may also be given in the dose of 1 to 2 grains to an 
adult in capsules or wafers. The crystals should be used, not the 
powdered santonin. If the bowels are not opened within ten hours 
after the drug is used, a saline purge should be given, preceded pre- 
ferably by a 2 or 3 grain dose of calomel, taken half an hour before. 

Administration. — Santonin is best given in the form of a troche 
or lozenge (Trochisci Saatonini, B. P.), but it is to be distinctly 
borne in mind, and written on the prescription, that the Trochisci 
Sodii Santoninatis, U. $., are not sold to the patient. The troches 
of santonin itself are not officinal in the U. S. P., and it is better for 
the physician to write for them as follows : 



R. — Santonin 

Pulv. sac. alb. 






. gr. v. 


Pulv. acacise 
Mix thoroughly, and add 

Acacise mucilag. . 

Aquae . 
To be divided in troches No. 


x. — S. 1 or 2 lozenges, as 


di 


• gr. viij, 

• gtt. xvj 

. q. s. 
rected. 



SARSAPARILLA. 

Sarsaparilla, U. S., is the root of Smilax Officinalis, Medica, and 
other species of smilax growing chiefly in Central America, it is 
known in the B. P. as Sarsoe Radix. The drug is largely devoid of 
any physiological action, yet seems to possess some power over the 
general condition of the system. Thus while sarsaparilla seems 
utterly without effect in the hands of most physicians when given alone, 
it often seems to do good and to increase the effects of other drugs when 
combined with them, so that some cases of syphilis which are of an 
obstinate character, will yield to iodide of potassium and sarsaparilla 



SAVINE. 265 

when the iodide alone fails. It is largely used in domestic medicine 
as a " blood purifier, " and is a prominent constituent of many patent 
medicines. 

Administration. — Sarsaparilla is most commonly given in the form 
of the compound syrup (Surujms Sarsaparillce Compositum, U. S.), 
composed of sarsaparilla, sassafras, guaiacum wood, liquorice, pale 
rose, anise, and mezereum, dose 1 to 4 fluidrachms. The other offi- 
cinal preparations of the U. S. P. are the compound decoction (De- 
coctum Sarsaparillce Compositum), composed of the same principal 
ingredients as the compound syrup, except anise, senna, and pale 
rose, dose 4 to 6 fluidrachms; the compound fluid extract (Extractum 
Sarsaparillce Compositum Fluidum), similar to the syrup in compo- 
sition, dose of J to 1 fluidrachm ; and the fluid extract [Extractum 
Sarsaparilla^ Jiluidum), dose J to 1 fluidrachm. The B. P. prepara- 
tions are a decoction (Decoctum Sarsce), dose 2 to 10 fluidounces ; a 
compound decoction (Decoctum Sarsce Compositum), which is the 
same as the decoction of the U. S. P. ; a liquid extract (Extractum 
Sarsce Liquidum), dose J to 4 fluidrachms. 



SAVINE. 

Sabina, U. S., Savince Cacumina, B. P., is the tops of the Juni- 
perus Sabina, an evergreen shrub of northern Europe, Asia, and 
America, It contains an officinal volatile oil (Oleum Sabince, U. S. 
and B. P.). Locally applied it is more of a counter-irritant than 
is turpentine, and if swallowed in poisonous amount causes nausea, 
vomiting, gastro-enteritis, unconsciousness, suppression of urine, and 
death. If the individual be a pregnant female abortion takes place 
as death approaches, but very rarely before this time. Profuse 
flooding nearly always accompanies the act. 

Therapeutics. — The oil taken in the dose of 5 to 10 drops, repeated 
every three or four hours, acts as a powerful stimulant to the uterus 
and ovaries, causing hyperemia and aiding in the production of 
menstruation in amenorrhea, and in adding tone to the parts in 
menorrhagia ; it is best given in emulsion or capsule. The fluid 
extract (Extractum Sabince Fluidum, U. S.) is given in the dose of 5 
to 15 minims; the tincture (Tinctura Sabince, B. P.) in the dose of 
20- minims to 1 drachm. The ointment (Unguentum Sabince, B. P.) 
is used as an external irritant. 



266 DRUGS. 



SOAMMONY. 



Scammonium, U. 8. and B. P., is a resinous exudate from the root 
of Convolvulus Scammonia, growing in Asia Minor and Syria. Its 
active principle is sometimes called jalapin. 

Therapeutics. — Scaminony is an irritant, drastic, hydragogue 
purge, causing a good deal of griping, and exerting a chologogue 
effect. If any inflammatory action of the bowels is present it is 
contra-indicated. 

Poisonous doses are to be followed by treatment suitable to gastro- 
enteritis. Scammony is given in the dose of 2 to 5 grains, always 
in combination with some other similar drug, as, for example, colo- 
cynth when it forms part of the compound extract of colocynth 
{Extradural Colocynlhidis Compositum, U. S.), dose 1 to 3 grains as a 
laxative, or 5 to 20 grains as a purge. The resin (Resina Scqm- 
monii, U. 8. and B. P.) is given in the dose of 3 to 8 grains. The 
B. P. preparations of scammony are Mistura Scammonii, dose J 
to 2 ounces; Confectio Scammonii, dose 10 to 30 grains; Pilula 
Scammonii Composita, dose 5 grains ; and Pulvis Scammonii Com- 
ppsitus, dose 10 to 20 grains. The last two preparations are com- 
posed of scammony, ginger, and jalap. 



SOOPARIUS AND SPARTEINE. 

Scoparius, U. S., Scopari Cacumina, B. P., or Broom, is the tops 
of the Sarothamnus Scoparius. It contains scoparin and sparteine, 
the first being a crystalline principle, and the second a liquid alka- 
loid. The second (sparteine) is the alkaloid used in medicine in the 
form of a sulphate. 

Physiological Action. — As scoparius depends for its medicinal 
value almost entirely upon sparteine, what is here said applies to 
both the drug itself and the alkaloid. 

Nervous. System. — Sparteine acts on the nervous system very 
decidedly if given in large dose, depressing the brain and spinal 
cord, chiefly in its motor tracts, thereby causing a decrease of reflex 
action and motor power, ending in complete paralysis. This occurs 
both in man and in the lower animals. The heart is said to be 
stopped in systole. 

Circulation. — Upon the circulation sparteine acts as a stimu- 
lant. It quickens the pulse rate in moderate doses, and also raises 
arterial pressure. The force of the contraction of the ventricles is 
also increased. In very large poisonous doses the drug acts as a cir- 
culatory depressant. 



SEIDLITZ POWDER. 267 

Respiration. — Upon this function in small amounts it has no 
effect, but poisonous closes kill by paralysis of the respiratory centre. 

Poisoning'. — The symptoms of poisoning consist in trembling and 
incoordination of movement, clonic and tonic convulsions, followed 
by a second stage of depression of the nervous system and general 
enfeeblement. 

Therapeutics. — Sparteine has been recommended in all states of 
the heart where digitalis is of service, and it is stated that it is ser- 
viceable in those fairly frequent cases where digitalis fails. In car- 
diac arhythmia or palpitation, it is thought to be of great service by 
those who have used it most. Clark found it of value in Graves's 
disease and in nearly every circulatory abnormality, but in the judg- 
ment of the author of this book sparteine is generally a useless drug 
to be resorted to as a last resource after more generally known 
remedies fail, and it is not a remedy to be used as a " standby " in 
the manner in which digitalis is employed. 

While some clinicians have found it of value, many of them have 
not. In the few cases in which it has been used by the writer it 
entirely failed to be of value. The dose is as variable as its action. 
Some state it to be -^ of a grain, while still others recommend 2 to 
4 grains. A small dose should be used at first, and rapidly in- 
creased until effects ensue. The drug should be given in watery 
solution. 

Scoparius itself is used in decoction, made by adding half an ounce 
of the broom tops to a pint of water, and boiling them down to a 
half pint. Of this, an ounce should be taken every three hours. 
This decoction is one of the most efficient diuretics in cardiac dropsy. 
An unofficinal fluid extract is given in the dose of 80 drops. The 
officinal preparations of the B. P. are a decoction (Decoctum Scoparii), 
dose 1 to 3 ounces, and the juice of Succus Scoparii, dose 1 to 2 
drachms. 

SEIDLITZ POWDER. 

Under the officinal name of JPulvis Ejfervescens Compositus the 
U. S. P. recognizes a purgative powder made by taking the bitartrate 
of sodium and potassium or Kochelle salt 120 grains and bicar- 
bonate of sodium 40 grains, which are wrapped in blue paper, and 35 
grains of tartaric acid placed in a second paper. The contents of each 
paper are dissolved in a little water — half a tumblerful, and the two 
solutions added to one another and swallowed during effervescence. 
As much as two powders may be used but this is generally too large 
an amount. In sick stomach with constipation where a whole powder 
cannot be retained, the two powders should be divided in fourths 
and a fourth added to a fourth in a half wineglassful of water and 
taken every 15 minutes until the entire powder is ingested. This will 
often settle the stomach and produce purgation. 



268 DRUGS 



SENEGA. 



Senega, TJ. S., Senegas Radix, B. P., is the root of Poly gala Senega, 
a small plant of the United States, containing a principle known as 
polygalic acid and senegin. 

Therapeutics. — Senega is used in medicine as a stimulating expec- 
torant in the sub-acute and chronic forms of bronchitis. It has also 
been employed as a diuretic in cardiac dropsy or that due to renal 
disease. In cardiac disease it should not be used, and indeed it is 
rarely employed at present except in combination with other drugs 
in expectorant mixtures. 

Administration. — Senega is used in the form of the abstract (Ab- 
stractum Senega?, TJ. S.), dose 5 to 10 grains, the fluid extract (JEJx- 
tractum Senega? Fluidum, TJ. S.), dose 10 to 20 drops, and the syrup 
(Syrupus Senegas, TJ. S.), dose 1 to 2 drachms. It is also used in 
Coxe's Hive Syrup. The officinal preparations of the B. P. are a 
tincture {Tinctura Senegas), dose 1 to 2 drachms, and an infusion 
(Infuswn Senegas), dose 4 to 2 ounces. 



SENNA. 

Senna, TJ. S., is the most drastic of the laxative purges used for 
the relief of constipation. It is the leaflets of Cassia Acutifolia and 
Cassia Elongata and contains a very acrid irritant purgative principle 
known as cathartic acid. Senna is officinal in the B. P. as Senna 
Indica and Alexandrina. 

Physiological Action. — Senna acts as a purge, producing copious 
stools, often with a great deal of griping if it is used alone. Accord- 
ing to Rutherford and Vignal, it acts very materially in increasing 
the flow of bile, but it is seldom used in medicine as a cholagogue. 

According to Prevost and Binet, cathartic acid has an influence over 
biliary secretion. Hess has found that the drug acts directly upon 
the mucous membranes and so produces a local peristalsis as it is 
moved along. It is also known that the drug acts as a purge when 
absorbed from the skin, and nursing mothers must not take senna as 
it will purge the nursling. 

Administration. — Senna is generally combined with other drugs in 
constipation but may be used alone. 

If this is done the fluid extract (Extractum Sennas Fluidum, TJ. S.) 
may be employed in the dose of 1 to 2 drachms to a child or 4 
drachms to an adult, or if the child is " set against " medicine, the 
more agreeable confection (Confectio Sennas, TJ. S. and B. P.) should 
be used, in the dose of J drachm to a child, or 1 to 2 drachms to an 
adult. As the confection is apt to cause dyspepsia, its use is limited 
to a certain class of cases. 



SILICATE OF POTASSIUM. 269 

In the constipation of pregnancy senna is thought to be very useful. 
Under the name of Black Draught a mixture of senna, manna, and 
sulphate of magnesium has been largely used (Infusum Sennce Compo- 
situm, TJ. S.), in the dose of 4 ounces. It is an active hydragogue 
purge. The syrup (Syrupus Sennce, TJ. S. and B. P.) is given in the 
dose of 1 to 4 drachms. 

One of the best ways to use senna is in the compound liquorice 
powder (Puhis Grlycyrrhizce Compositus, U. 8. and B. P.), which is 
a good laxative in the dose of 20 to 30 grains. 

Iwfusum Sennce, B. P., is given in the dose of 1 to 2 ounces; Mis- 
tura Sennce Composita, B. P., in the dose of 1 to 2 ounces, and 
Tinctura Sennce, B. P., in the dose of 1 to 4 drachms. 

Senna may stain the urine red and no alarm should be felt if this 
color appears in this secretion. 



SERPENTARIA. 

Serpentaria, U.S., Serpentaria Bhizoma, B. P., or Virginia Snake 
Root, is the rhizome and rootlets of Aristolochia serpentaria and Aris- 
tolochia reticulata, plants of the southern United States. It contains 
an active principle, Aristochine, which is never used in medicine. 

Therapeutics. — Owing to the rather pleasant, warm taste of ser- 
pentaria, and the fact that it acts upon secretion, it is used largely as 
a vehicle for other more potent remedies. It has tonic properties 
and has been largely used in atonic dyspepsia and indigestion. It is 
even said to be a sexual stimulant but this is doubtful to say the 
least. In overdose it is irritant and will cause vomiting and purging. 

Administration. — Serpentaria is given in the form of the extract 
(Extr actum Serpentaria Fluidum, TJ. S.), in the dose of 10 to 40 drops 
and the tincture {Tinctura Serpentaria, TJ. S. and B. P.), in the dose 
of J to 2 drachms. It also enters into Huxham's tincture of cinchona 
(Tinctura Cinchonce Composita, TJ. S. and B. P.). Infusum Serpen- 
tarice, B. P. is given in the dose of 1 to 2 ounces. 



SILICATE OF POTASSIUM. 

Soluble Glass occurs as a clear syrupy fluid, and is not officinal. It 
is used as a dressing for fractures and sprains, rapidly becoming 
hard and immovable when painted over the bandages. It may be 
substituted for the plaster-of- Paris. 



270 DRUGS. 



SOAP. 



Sapo, U. S., Sapo Duris, B. P., is prepared from any alkali and 
fixed oil, although soda and olive oil are most frequently employed 
for medicinally used soaps. Castile soap, if good, is the best repre- 
sentative of a pure medicinal soap that we have. 

Soap may be cut into the form of a suppository for provoking 
passages in constipation in children, by placing it just inside the 
anus, having previously dipped it into water one instant to make it 
slippery. It may also be used as an enema, dissolved in warm water, 
or a mixture known in Philadelphia as the "House mixture" may 
be employed. This consists of a mixture of water, soft soap, and 
molasses in varying proportions, or, if there is flatulence, turpentine 
and olive oil are added to it. This preparation is as efficient as it is 
cheap and dirty. Soap is also used as an antidote to many poisons 
and as aid to emetics. 

Green Soap (Sapo Viridis, U. S., Sapo Mollis, B. P.) is not generally 
green but brown. It is a soft soap made by the use of potash and 
olive oil and largely used by dermatologists in the treatment of 
eczema and similar skin diseases where a detergent, stimulating ap- 
plication is needed. It is sometimes called '* German soft-soap" to 
separate it from ordinary soft-soap, or sapo mollis. Green soap is 
not commonly employed as green soap, but in the tincture (Tinctura 
Saponis Viridis, U. S.), which is to be thoroughly rubbed into the 
part and afterward well washed oif and simple cerate or some other 
soothing salve applied. 

Soap Liniment {Linimentum Saponis, U. S. and B. P.), or Opo- 
deldoc as it is called in domestic medicine, is largely used for rubbing 
stiff muscles and sprains. It is generally used to carry more active 
external remedies, such as opium or aconite. 

Soap Plaster (Emplastrum Saponis, U. S.) is used as a thick, heavy 
protective in bed-sores or where bed-sores are feared. It is also used 
as a support about sprained joints. 



SODIUM. 

Sodium is a non-metallic element, the salts of which are usually 
white and colorless. It is not used in medicine, but many of its salts 
are employed. Unlike the potassium salts, it seems to exert compara- 
tively little effect on the animal economy. The salts vary in their 
power with the acid forming them. (For the salts, see the names of 
the acids, as Chloride of Sodium, etc.) 

Acetate of Sodium (Sodii Acetas, U. S. and B. P.) is rarely if ever 
used in medicine as a substitute for acetate of potassium. Its dose is 
20 to 40 grains three times a day. 



SOZOIODOL. 271 



SODIUM ETHYLATE. 

Sodium Etbylate is a whitish powder decomposed in the presence 
of water into alcohol and caustic soda, but soluble iu absolute alcohol 
without decomposition. 

Sodium ethylate is employed in mediciue as a depilatory — that is, 
for the purpose of removing hairy growths. To accomplish this 
purpose it is necessary that the growth be clipped close to the skin, 
and that the drug be dissolved in absolute alcohol and applied over 
the roots of the hair with a glass rod. 

Soon after this application a crust forms, which should not be de- 
tached for two or three weeks, but which, on its removal at the end 
of this time, generally shows that all of the hair has been destroyed. 
If not, the operation may be repeated as soon as the skin is in a con- 
dition to stand it. To relieve pain a five per cent, solution of coca- 
ine may be applied, and it is worthy of remembrance that moles and 
small birth-marks, or nsevi, maybe relieved by a similar application. 



SOMNAL. 

Somnal is stated to be ethylated chloral-urethan, and seems to 
possess marked hypnotic power. It is a clear, colorless liquid of a 
hot, burning taste, resembling sweet spirit of nitre. The dose is 20 
to 40 drops in licorice- water or syrup of raspberry, and the sleep 
produced by it is said to last seven to eight hours. The remedy is 
so very new that no defiuite reports have yet been made of it. 



SOZOIODOL. 

Sozoiodol differs in one respect from other antiseptics, so far 
as our patriotism is concerned, in that it was first made and em- 
ployed by one of our own countrymen in San Francisco, but at 
that time the preparation of it was so imperfectly carried out that 
foreign matters made it too irritating for general use, and it was dis- 
carded, only to be better prepared and more widely used in Germany 
some years later. 

Therapeutics. — Sozoiodol has been found of value as an antiseptic 
and disinfectant in wounds which are in a diseased state, and in acute 
stomatitis and pharyngeal catarrh it may be employed locally in the 
form of a five per cent, watery solution. It has also been found 
useful in acute purulent conjunctivitis, and in ophthalmia neona- 
torum, in the proportion of two parts of sozoiodol to thirty parts of 



272 DRUGS. 

water. In urethritis, of a specific type, we may employ the prep- 
aration known as zinc-sozoiodol in a 2 per cent, solution with 
advantage, and it is of value in mild and malignant vaginitis if 
preceded by an application of pyroligneons acetic acid or nitrate of 
silver, by means of a speculum. 

In the treatment of gynecological cases, particularly in catarrh of 
the cervix uteri, Nitschman uses sozoiodol in the form of a powder 
applied by means of a tampon with good results, and it would seem 
as being worth a trial in many other states of the mucous membranes 
than those just named. 



SPIGELIA. 

Spigelia, U. S., Pinkroot, is the root and rhizome of Spigelia 
Marilanclica, or Carolina Pink, a plant of the southern United 
States. 

Poisoning. — Almost immediately after the ingestion of a poisonous 
dose the animal has short and quick expiratory movements, amount- 
ing almost to a cough. 1 Soon after the pupils become widely dilated, 
and at the same time very fixed in this position so that they cannot 
follow any object, such as a pencil, when it is moved from side to 
side. Constant retching, with no result, now comes on, the animal 
standing and apparently suffering from no sensory or motor palsy. 
There is no change in gait. Soon after this marked exophthalmia 
develops itself. The retching, having lasted about five minutes, now 
passes off, and at this time signs of muscular weakness and lack of 
coordination appear and the walk becomes staggering both in the fore 
and hind legs. The respirations now become very rapid, resembling 
those of a dog after a long, hot run. The tongue hangs from the 
mouth and is dry and red, and the nose is hot and no longer moist. 
Muscular power is progressively lost, so that the dog frequently falls 
when endeavoring to walk, but sensation does not seem to be affected. 
About this period the animal lies down and passes into a deep sleep, 
which, in turn, soon changes into coma, and death follows without 
any movement being made, evidently from a general failure of vital 
force. The respirations, as death approaches, become slow, and are 
finally extinguished simultaneously with cardiac arrest. The palsy 
is spinal in origin, the motor and sensory nerve-trunks and the mus- 
cles escaping. 

Therapeutics. — Spigelia is one of the most efficient remedies in 
the treatment of round-worms, and is not dangerous when given 
with care. When employed the usual care should be taken in re- 
gard to food (see Worms), and it should be followed by a purge to 

1 See investigation by author in The Medical News, March 12, 1887. 



SQUILL. 273 

sweep out the worm while it is narcotized by the drug. The purge 
should be a rapidly-acting one, such as sulphate of magnesium. 

Administration. — The dose of spigelia, in the form of the fluid 
extract {Extractum Spigelian Fhddum, TJ. S.), is 2 drachms ; that of 
the unofficinal fluid extract of spigelia and senna (Extractum Spigelia 
et Sennce Fhddum) is J to 1 drachm for a child of two years of age; 
\ an ounce is the dose for an adult. This extract with senna makes 
the drug more efficient, and it is generally liked by children. It is 
to be remembered it is not officinal. 



SQUILL. 

Scilla, TJ. S. and B. P., is the sliced bulb of TJrginea Scilla or Scilla 
Maritimcb) a plant of the countries bordering on the Mediterranean. 
It contains Scillin, Scillipikrin and Scillitoxin, and all of which 
possess poisonous properties and none of which are used in medicine 
alone, except by a few persons. 

Poisoning 1 . — In poisonous doses squill produces vomiting, purging, 
duluess, stupor, intermittent palsy, convulsions, and death in ten to 
twenty hours. This is preceded by a great fall in temperature. The 
urine is suppressed or bloody and acute nephritis is set up. Gastro- 
enteritis may be marked. 

Therapeutics. — Squill is largely used as a stimulant or irritant 
diuretic, not to affect the renal epithelium directly and promote se- 
cretion, but rather to tone up and excite to normal effort a kidney de- 
pressed by disease as in very chronic Brighfs Disease or congestion 
from cardiac trouble. In cardiac dropsy combined with digitalis it 
is a standard and much used remedy, and is undoubtedly of value in 
aiding in the absorption of effusions into the pericardium, pleura, and 
abdomen. Squill is usually given in dropsy in pill form as follows : 

R. — Pulv. scillse. ....... gr.x. 

Pulv. digital, fol. ...... gr.xx. 

M.— Ft. in .PH. No. x. S. One t. d. after meals. 

The employment of squill in br^onchitis, although largely resorted 
to, is not a very good practice since its irritant action on the kidneys 
and stomach may cause trouble. The period for its administration is 
the second stage when secretion is scanty or so excessive as to need 
proper stimulation of the mucous membranes to bring on a healthy 
action. Sometimes Coxe's Hive Syrup is used, either as an emetic 
in drachm doses every ten minutes until it acts, or as an expectorant 
in the dose of 30 drops to a drachm for an adult. As it contains 
antimony it should be given with care. 

Administration. — The fluid extract (Extractum Scillce Fhddum, 
TJ. S.) is given in the dose of 1 to 5 drops ; the tincture (Tinctura 
Scillce, TJ. S. and B. P.), in the dose of 5 to 30 drops; the vinegar of 

18 



274 DRUGS. 

squill (Acetum Scillce, U. 8. and B. P.), in the dose of 10 drops to J 
drachm. The compound syrup (Syrupus Scillce Compositus, U. S.), or 
Coxe's Hive Syrup, is composed of squill, tartrate of antimony and 
potassium, precipitated phosphate of calcium, alcohol, sugar, and 
water, and is given in the dose of 20 drops to a drachm. 

The following will be found useful in bronchitis of the subacute 
stage. 

R. — Vin. ipecac. . . . . . . . . fgj. 

Tine, scillse ....... f^ij. 

Syr. tolutan. . . . . . . . f,^v. 

Aquae. fgj. 

M. — S. Teaspoonful every 3 or 4 hours. 

The plain syrup (Syrupus Scillce, U. S. and B. P.) is given in the 
dose of \ to 1 drachm; the honey (Oxymel Scillce, B. P.), in the dose 
of J to 1 drachm, and the compound pill (Pilula Scillce Composita, 
B. P.) in the dose of 5 to 10 grains. 



STILLINGIA. 

Stillingia, U. S., Queen's Root, is the root of Stillinyia Sylvatica, a 
plant of the United States, the active principle of which is stillingin. 

Physiological Action. — There can be no doubt that this drug acts 
in two ways. First, by its immediate effects on the system; and, 
second, by its more slowly shown influences. In overdose it causes 
bilious purging, increased heart action, and active secretion from the 
bronchial mucous membrane. 

Therapeutics. — Stillingia is highly recommended in habitual con- 
stipation, as it increases intestinal secretion, and it is even said to act 
as a specific in hemorrhoids dependent largely for their existence 
upon hepatic engorgement and intestinal atony. 

Bartholow recommends the following prescription under these 
circumstances : 

R. — Extract stillingia? fluid. f£ v « 

Tine, belladonna? ~\ 

Tine, nucis vomicae j- . aa f gj. 

Tine, physostigmatis J 
M. — S. 20 drops in water t. d. before meals. 

Tincture of aloes may also be added if necessary. In syphilis of 
an obstinate, rapid type, stillingia should be used as an aid to other 
drugs. 

In pasty-looking, white, "putty-faced" children who are anaemic 
or strumous, and who never have any appetite, or are subject to 
middle-ear trouble and general debility, stillingia is of value. It 
should be used under these circumstances for some time. 

The only officinal preparation is the fluid extract (Extractum Stillin- 
gice Fluidum, U. S.), the dose of which is 10 to 60 drops, which should 
always be made of the fresh root. 



STKOPH ANTHUS. 275 



STRAMONIUM. 



Jamestown Weed, or Datura Stramonium, is officinal in the form 
of the leaves (Stramonii Folia, U. S.) and seeds (Stramonii Semen, 
17. S. and B. P.). It contains an alkaloid known as daturine, which 
is physiologically identical with atropine. 

Physiological Action. — (See Belladonna.) 

Therapeutics. — The uses of stramonium are identical with those 
of belladonna, 

Administration. — The extract (Extractum Stramonii, U. S. and 
B. P.) is used in the dose of -J to -J- grain, the fluid extract (Extractum 
Stramonii Fluidum, U. S.) in the dose of 1 to 5 drops, the tincture 
(Tindura Stramonii, U. S. and B. P.) in the dose of 5 to 30 drops. 
The -ointment (Uugaentum Stramonii, U. S.) is used as is belladonna 
ointment. The dose of daturine is y-^ to -^ of a grain. 



STROPHANTHUS. 

The seeds of Strophantus Hispidus, an African plant from which 
the natives make Kombe arrow poison. There are many varieties of 
strophanthus. The active principle is strophanthin, from which is 
derived strophanthidin. 

Therapeutics — Strophanthin may be used in all forms of cardiac 
disease to supplant digitalis, but it is not its equal. 

From the cases of cardiac disease seen frequently by the writer he 
has reached the conclusion that digitalis gives relief to patients under 
the age of twelve years in a much smaller proportion of cases than it 
does in adults, and that though the stomach is no more frequently 
disordered, increased dyspnoea, nervous irritability, and cyanosis 
often follow its use. 

As every one knows, there are a certain number of cases where 
digitalis seems to do harm in adults, the explanation being that 
under such circumstances the ventricle is so overstimulated that the 
auricle cannot empty itself thoroughly, and becomes congested in 
consequence. 

Strophanthus acts exceedingly well in these instances where digi- 
talis fails, and this is particularly true in adults. It will relieve car- 
diac dropsy by its action on the heart, but it is not diuretic in itself. 

Administration. — Strophanthus is given in the form of the tincture 
in the dose of 3 to 6 drops three times a day. Strophanthin may 
be given hypodermically in the dose of t ^-q- to -^ of a grain. Its 
effects, when so used, are said to last a week, but this is not likely. 



276 DRUGS. 



SUGAR. 



Saccharum, U. S., Saccha?'um Purificatum, B. P., is the refined 
sugar of Saccharum Officinarum, or Sugar Cane, it is also obtained 
from the sugar beet. It is an anti-putrefactive but not an anti- 
fermentative. Mixed with iron preparations it prevents oxidation. 
As it is a hydro-carbon it is a nutrient and developer of adipose 
tissue, or, in other words, a food. Its use is contra-indicated in 
obesity, during the presence of fermentative changes in the intestine, 
and in diabetes mellitus. 



SUGAR OF MILK. 

Saccharum Laclis, U. S. and B. P., is derived from the whey of 
cow's milk, in the proportion of about 5 per cent., by evaporation 
and purified by re-crystallization. It has little sweetening power 
compared to cane sugar and possesses a peculiar flat taste. It is, how- 
ever, less apt to ferment and is better for infants than is cane sugar. 

Milk sugar is largely used in triturations because by its hardness 
it aids in the subdivision of the medicament. It is also used to in- 
crease bulk in small powders, where such drugs as podophyllin are 
prescribed. 

SULPHATE OP ZINC. 

Zinci Sulphas, U. S. and B. P., is a white, somewhat efflorescent 
salt, and of sharp acid taste, soluble in water. In large amounts it 
acts as an irritant, and is widely employed as an irritant peripheral 
emetic in the dose of 10 to 30 grains. It is not so severe as sulphate 
of copper in its poisonous properties and may be repeated if the first 
dose does not produce vomiting. In weak solutions it may be used 
as an astringent application in gonorrhoea and other affections of the 
mucous membrane. In 2 grain pills it is sometimes given in serous 
diarrhoeas, particularly if it be combined with opium or minute doses 
of podophyllin (-g 1 ^ of a grain at a dose). In conjunctivitis and other 
eye affections the drug is used in the form of a wash. (See Conjunc- 
tivitis.) 

SULPHIDES. 

Baths of the various sulphides, such as are obtained at sulphur 
springs, are very useful in many cases of skin disease of an obstinate 
type, such as psoriasis, lichen and eczema. They are also employed 
in chronic rheumatism and gout. 



SULPHONAL. 277 

In laryngeal hoarseness and pharyngeal affections, such as follow 
public speaking and exposure to cold, sulphides or sulphur waters 
are very useful, and little doubt exists but that their employment 
is one of the best ways to cure the obstinate state of the throat some- 
times seen in public speakers. 

As was first noted by Dr. Ringer, the sulphides, particularly in 
the form of calcium sulphide, are very useful in all cases where pus 
is about to form. 

They may be employed in cases where successive crops of boils 
occur and in adenitis of the neck and elsewhere. If they do not 
stop the formation of pus they aid in its inspissation and absorption. 
Children should take a teaspoonful of a solution containing a grain 
of calcium sulphide, or calx sulphurata, to the half-pint of water 
every hour. Adults should use sulphide of calcium in gelatin- 
coated pill, dose |to| a grain three times a day. The solution 
must be freshly prepared, as it undergoes oxidation and changes into 
a sulphate. 

SULPHONAL. 

Sulphonal is a synthetically prepared substance first manufactured 
in Germany by Baumann, and possesses the chemical name of 
diethylsulphon-dimethyl-methane. It is a colorless, odorless, solid 
substance, soluble in 100 parts of cold and 18 to 20 parts of hot- 
water, readily soluble in alcohol and ether. The drug is not affected 
by any of the ordinary acids, and is very stable. 

Physiological Action. — Several quite interesting researches upon 
this comparatively new hypnotic have been carried out during the 
past year. Smith, of London, has studied its action on the activity 
of tissue-change, and has also attempted to determine the changes 
in the drug during its passage through the body. In regard to the 
first question he found, by experimenting upon a powerful, healthy 
dog, weighing thirty-five pounds, which was fed upon one pound of 
dog-biscuit and one quart of water daily, that the amount of urea 
during the administration of sulphonal is a little greater than that 
eliminated during the period when no drug is given. He also found 
that the urine is slightly increased in amount under the influence of 
the drug. The changes were, however, so very slight that he reaches 
the conclusion that moderate doses of sulphonal do not affect the 
destruction of nitrogenous tissues. In regard to the second question 
•Smith quotes the results of Kast, namely, that sulphonal does not 
pass into the urine as such, but iu the form of a sulphuretted organic 
compound. Smith therefore directed his attention to the endeavor 
of finding out whether the entire amount of the drug ingested is 
changed or not. Without taking up space with a full consideration 
of his method of experimentation, we find that his conclusions may 



278 DRUGS. 

be summed up as follows : Iu moderate doses the drug is completely 
changed during its passage through the body iuto a sulphuretted 
organic substance, and the elimination of sulphuric acid is uot in- 
creased by taking sulphoual. In the publication quoted Dr. Smith 
does not give us the exact uature of the substance derived from sul- 
phonal, but promises to inform us further concerning it in a later con- 
tribution. Another paper upon the physiological action of sulphonal 
has been published by Dr. William F. Shick, of Easton, Pa., who has 
found, after a series of experiments, first, that sulphonal when given 
by the stomach acts very slowly on account of its insolubility ; but that 
subcutaneously in warm solution it is much more active. The drug 
was also found to produce a general relaxation of the muscles, and a 
staggering gait after its hypnotic power had passed by. The spectro- 
scope failed to show any changes in the blood. The motor nerves 
are not affected. Shick believes that the action of the drug is ex- 
pended upon the higher nerve-centres. He also found a decreased 
reflex activity, and believes this lessening to be due to stimulation of 
Setschenow's reflex inhibitory centre. On the circulation the drug 
was found to have but little power. When sent directly into the 
blood there is produced a slight decrease in arterial pressure, followed 
very soon after by an increase. Upon the respiration the drug is 
found to act as a depressant in full doses. 

Therapeutics. — Sulphonal finds its place in medicine as a somnifa- 
cient or hypnotic, valuable where nervous functional insomnia is 
present, useless where advanced disease, such as cardiac trouble, is 
responsible for the wakefulness. In insanity it often produces sleep^ 
and is often of great service in the various mental disturbances char- 
acterized by lack of sleep and often affecting persons of unsound 
mind. Sulphonal may be defined very briefly by any one who has 
largely used it or watched the reports made of its progress. This 
definition is that the drug does possess sleep-producing power of 
moderate amount, not equal to chloral or potassium bromide, but 
greater than that of paraldehyde, and that it will sometimes succeed 
where the other hypnotics fail. 

Administration. — Sulphonal being virtually insoluble in cold water 
is best given in large capsules or in mucilage of acacia, so as to be 
held in suspension until swallowed. The drug is bulky and hard to 
administer for these reasons. The dose is 20 to 40 grains. 



SULPHUR. 

Sulphur is a non-metallic element officinal in three forms in the 
U. S. P., namely, as Sulphur Lokcm, or washed sulphur, Su'phur 
Precipitatum, TJ. S. and B. P., or precipitated sulphur, and Sulphur 
Sublimatum, or flowers of sulphur. 



SULPHUR. 279 

Physiological Action. — Sulphur has little physiological influence 
over the general system. Wheu taken internally it causes a soft mushy 
stool of a yellow color, with a strong odor of hydrogen sulphide. 
The drug acts particularly on the skin and mucous membranes. 
The juices of the intestiues break some of it up into sulphuretted 
hydrogen and sulphides. 

Therapeutics. — Sulphur is used as a mild laxative, never purging. 
In stricture of the bowels the soft stools produced by it will often slip 
by the obstruction, and it is worthy of note that sulphur will some- 
times relieve constipation which nothing else will give relief. It is 
particularly valuable in the treatment of 'constipation where there are 
hemorrhoids, and in chronic rheumatism and sciatica it is thought by 
some to effect a cure. 

Sulphur is of great service in the treatment of chronic bronchial 
affections but for some curious reason its use has become almost obse- 
lete. The so-called Bergeon's method of treating phthisis by rectal 
injections of carbonic acid gas loaded with sulphuretted hydrogen 
was simply a revival of an old knowledge possessed by our great- 
grandfathers who often used sulphur waters by the mouth. Bergeon 
took the trouble to go to the back door to accomplish what was done 
200 years ago by the front door, and the only novel part of his 
m'ethod was his filthy way of using the drug. Graves recommended 
5 to 10 grains of sulphur three times a day wherever bronchial se- 
cretion was excessive, and found that it rid the lungs of mucus and 
relieved the cough. 

The external use of sulphur is very much more important than its 
internal use, particularly as regards affections of the skin. Of itself 
the drug exercises little effect when used in powdered form over the 
cuticle, but its combination with an ointment at once makes it active. 
Even irritations of the skin may ensue from its constant use in con- 
centrated form. 

In scabies, or itch, sulphur ointment (Unguentum Sulphuris, U. S. 
and B. P.) is the best remedy we have. The female parasite burrows 
under the epiderm and deposits the ova as she moves about while the 
male does not burrow but stays on the surface. The ointment will 
kill him, as he is readily attacked, but the female is protected by her 
burrowing propensities. To get at her and the ova the burrows may 
be opened, and this must be accomplished by a thorough soaking 
with soap and water, thereby softening the skin and aiding in its re- 
moval by a rough towel. The towel should be at once boiled to 
prevent its conveying the parasite to others. The ointment if now 
applied relieves the patient almost at once. It is important that the 
skin be well softened and rubbed, in order to open every burrow. 
The ointment should be allowed to remain on the part all night and 
be used for three or four nights consecutively. 

Young females often suffer from acne, particularly about the men- 
strual epoch, the skin also becoming sallow and muddy. Ringer 



280 DRUGS. 

recommends the following lotion as one which is very successful in 
promoting a cure : 

R. — Sulphur sublimati gj. 

Glycerine f^j. 

Aquae rosae f ^ viij. 

M. — S. Apply as a wash once or twice daily. 

A confection (Confectio Sulphuris) is officinal in the B. P., dose 
10 grains to 2 drachms. 



SULPHIDE OP CALCIUM. 

See Calcium, Calx, or Sulphides. 

SULPHURIC ACID. 

Acidum Sulphuricum, U. S. and JB. P., Sulphuric Acid, or Oil of 
Vitriol, is a powerful irritaut and escharotic, rapidly dehydrating and 
carbonizing the tissues, causing them to become black. It is the 
most astringent of the mineral acids, and when absorbed is converted 
into sulphates and so eliminated by the kidneys, the lower bowel, and 
the skin. 

Poisoning. — The symptoms produced by poisonous doses are those 
of a gastro-intestinal inflammation of the most severe type, or the 
patient may drop to the floor almost at once owing to collapse, de- 
pendent upon perforation of the walls of the oesophagus or stomach 
by the acid and its escape into the peritoneal cavity. If the patient 
lives to the fourth day the parotid glands swell, as the result of sten- 
osis of the salivary ducts of Steno, and violent inflammation of the 
kidneys may appear. If partial recovery takes place the patient often 
dies from inanition due to the formation of strictures in the aliment- 
ary canal or to destruction of the peptic tubules. The stain about the 
mouth is black and if any of the acid is spilt on the clothes, its 
characteristic burn is to be seen. 

The treatment consists in the use of alkalies, such as chalk, mag- 
nesium, whitewash off the walls, and soap. Opium and oils are to 
be given to ally irritation and external heat is to be applied. 

Therapeutics. — Sulphuric acid is sometimes employed as a caustic 
to venereal sores, warts, and slowly healing ulcers, but is most commonly 
used internally as it fulfils several pressing indications. As a remedy 
for serous diarrhoea, particularly if combined with some vegetable 
astringent, it is unsurpassed, and its use in cholera deserves great at- 
tention. (See Diarrhoea.) In the Philadelphia Hospital during an 
epidemic of cholera some years since, every case which received it im- 
proved or failed to be attacked, whereas those who did not receive it 
were either very ill or died. 



SWEET SPIRITS OF NITRE. 281 

The proper way to use the drug as a prophylactic in cholera is in 
the form of " sulphuric-acid lemonade/' made so that each wineglass- 
ful contains 5 drops of the aromatic sulphuric acid. The same solu- 
tion should be used in acute lead-poisoning in order to form an 
insoluble sulphate of lead, and may be taken by artisans exposed to 
chronic lead-poisoning as a prophylactic for the same reason. 

As sulphuric acid is eliminated by the skin it is often useful in 
the night-sweats of phthisis combined with belladonna or morphine. 

Administration. — The dose of the dilute acid (Acidum Sulphur- 
icum Dilutum, U. S. and B. P.) is 10 to 30 drops, and of the aro- 
matic acid (Acidum Sulphuricum Aromaticum, U. S. and B. P.) 10 
to 20 drops. The last is the best preparation. Both should be 
thoroughly diluted. 

SUMBUL. 

Sumbul, U. S., is the root of Ferula Sumbul, a large plant of 
Northern Asia. The dose of the root (Sumbul Radix, B. P.) is 10 
to 40 grains. On the nervous system it acts as an efficient nerve 
tonic, and is very largely employed by Goodell in nervous exhaustion 
and in the unrest of nervous females. It is officinal in the tincture 
(Tinctura Sumbul, U. S. and B. P.), dose 1 to 4 drachms. 
Goodell uses the following formula : 

R. — Ext. sumbul. ....... gr. xx. 

Ferri sulph. exsiccat. ...... gr. xx. 

Asafoetidge ........ gr. x. 

Acid, arsenios gr. \. 

M. — Ft. in pil. I^o. xx. S. One t. d. after meals. 

To be of any value the preparation must be fresh aud the crude 
drug from which it is made must be good. 



SWEET SPIRIT OF NITRE. 

Sweet Spirit of Nitre (Spiritus JEbheris Nitrosi, U. S. and B. P.) 
or Spirit of Nitrous Ether is a mixture of alcohol, water, and ethyl 
nitrite. It is upon this last constituent that most of its value as a 
remedial agent depends. The drug as generally sold by pharmacists 
or others, who are not very careful to keep fresh preparations, is no 
better than alcohol and water alone, since the ethyl nitrite readily 
escapes, and deterioration at once asserts itself. Until recently the 
profession have had no ready means of protecting themselves from 
such poor preparations, but at present we know that all that is 
necessary is to add a grain or two of antipyrine to a half ounce or less 
of the spirit. If the ethyl nitrite be present a purple color followed 



282 DKUGS. 

by a green precipitate will be found. This green precipitate is iso- 
nitroso-antipyrine, which is not in the least poisonous. 

Physiological Action. — Sweet spirit of nitre is a sedative to the 
circulatory and nervous system and a diaphoretic and diuretic accord- 
ing to the manner in which it is administered. 

If given in very full doses it rapidly produces the cyanosis char- 
acteristic of the full effects of any one of the nitrites. (See Amyl 
Nitrite.) 

Therapeutics.— There is probably no remedy so widely employed 
by the laity as a household remedy which is so potent for good and 
yet so harmless, if wrongly used, as is this one. 

Physicians often place less reliance upon it than it deserves, and 
in nearly every instance where it fails it is either not indicated or 
the nitrite has escaped and left it posverless. 

In incontinence of urine in children the combination as given 
below is very useful in certain cases. (See Incontinence of Urine.) 
In these instances the urine will be found high colored and concen- 
trated, and therefore capable of irritating the bladder and general 
urinary tract. 

I£. — Potas. citratis ^j to gij. 

Spt. aether, nitros 1 '% ss. 

Aqu93 q. s. i'J; iv. 

M. — S. Dessertspoonful every five hours until urine becomes clear. 

As soon as the urine is clear belladonna may be used ; the 
citrate of potassium and spirit of nitre being continued, or not, as 
the case demands. 

Where the spinal centres are depressed and there is general atony 
of the system it may be well to substitute the following pill for the 
belladonna : 

R . — Acid, arsenios. ....... gr. \. 

Ext nuc. vom . . gr. lj. 

Quin. sulph gr. xx. 

M. — S. One pill t. d. after meals. 

The diuretic action of sweet spirit of nitre is best obtained, when 
it is wished to cause increased renal secretion, by using the drug in 
ice-cold water and keeping the patient lightly covered and cool. On 
the other hand, if a diaphoretic influence is desired it may be given 
simultaneously with warm lemonade, and the patient should be well 
blanketed. 

This last action of sweet spirit of nitre has made it a remedy of 
common use in treating acute colds in adults and children, and in 
setting aside the fever of these conditions in the latter class as well. 

Sweet spirit of nitre is a distinct antispasmodic and can be well 
employed where slight nervous excitement accompanies fevers or other 
states in infancy. 



TANNIC ACID. 283 

The dose for an adult is from 20 drops to 1 drachm, and for a 
child of one year 2 to 5 drops, which should always be given in cool 
water to this class of patients. 



TAMARINDS. 

Tamarindus, U. S. and B. P., is the preserved pulp of Tamarindus 
Indica, a tree of the West Indies. 

The taste is a peculiar mixture of bitter sweet. As a laxative it 
exerts little power over that of any ordinary fruits, such as apples, 
but it enters into the confection of senna (Confedio Sennce, U. 8. 
and B P.). Patients often find tamarinds a very agreeable laxative 
taken before going to bed or eaten as a confection after meals. 



TANNIC ACID. 

This acid when pure is a solid, uncrystallizable, white or yellowish- 
white powder without bitter taste and very soluble in water or glyc- 
erin. It is not so soluble in alcohol and ether. It is the chief prin- 
ciple of vegetable astringents, and occupies the relative position of an 
alkaloid to a crude drug, so far as the active portion of these vegetable 
astringents is concerned. 

Physiological Action. — Tannic acid when brought in contact with 
any of the tissues of the body constringes them and decreases their 
vascularity for a time, by causing contraction of their bloodvessels. 
For these reasons it stops secretion and condenses parts of the body 
which are relaxed and feeble. Applied to blood it forms a clot 
with great rapidity through coagulation of the albumen. Tannic 
acid is absorbed as gallic acid and eliminated as such, only acting as 
tannic acid before absorption. This is important to remember, since 
we learn from this that tannic acid is to be used to check haemorrhage 
only where the drug can be brought in direct contact with the bleed- 
ing point. If a haemorrhage is to be reached through the circula- 
tion, as in renal bleeding, gallic acid is to be given, as it is absorbed 
at once without change. 

Therapeutics. — Tannic acid is used in medicine to control haemor- 
rhage, to act as an astringent to relaxed tissues as in diarrhoea of 
the atonic or serous type, or in localized or general sweating. It is 
also of service for the purposes of toughening mucous membranes or 
parts of the skin which are exposed to much rubbing, as in the case 
of the nipples of a primipara, or where the feet get macerated and 
sore, or sweat profusely on exercise being taken. In hcemoptysis, 
tannic acid may be used dissolved in water, as a fine spray in the 
proportion of 5 to 10 grains to the ounce. Glycerite of tannin is 



284 DRUGS. 

made by adding 2 troy ounces of tannic acid to a J pint of glycerin 
and mixing at a gentle heat until solution occurs. It is useful as an 
application to slow ulcers and depressed mucous membranes, as in the 
mouth. In haemorrhoids of the bleeding type tannic acid suppositories 
are often very useful, and cotton saturated with tannic acid solution 
is often used as a packing in vaginal leucorrhoea. 

Administration. — The dose of tannic acid is 2 to 10 grains, best 
given in pill. The officinal preparations are: the troches (Trochisci 
Acidi Tannici, U.S.) each containing 1 grain of tannin, and an oint- 
ment ( Unguentum Acidi Tannici). The B. P. preparations are 
Crlycerinum Acidi Tannici ; Suppositoria Acidi Tannici, each contain- 
ing 3 grains, aud Trockisci Acidi Tannici, containing \ grain of the 
acid. 

TANSY. 

Tansy (Tanacetum, U. S.). The leaves and tops of Tanacetum 
Vulgare yield a volatile oil {Oleum Tanacetum) which possesses era- 
menagogue powers and has been largely used as a uterine stimulant. 
It is also used as an anthelmintic. 

In poisonous dose it causes epileptiform convulsions in some cases 
and deep coma, with death from respiratory failure. 

The dose of the oil as an ernmenagogue is 1 to 3 drops. 

In domestic medicine tansy tea, made by adding 1 ounce of the 
leaves or tops to 1 pint of water, and given in the dose of 1 to 2 
ounces is largely employed as a remedy for amenorrhea. 



TARAXACUM. 

Taraxacum, U. S., Dandelion, is a very old remedy for hepatic 
torpor and the dyspepsia resulting therefrom. It should be pre- 
pared from the fresh leaves or roots, as the dried stale plant is inert. 
From disregard of this fact much disappointment has arisen. Owing 
to its bitter taste it acts as a tonic. The extract (Extractum Tarax- 
ici, U. 8. and B. P.), dose 5 to 30 grains, and the fluid extract (Ex- 
tr actum Taraxici Fluidum, V. S.), dose 1 to 3 drachms, are the only 
officinal preparations. Succus Taraxici, B. P., is given in the dose 
of 1 to 2 drachms, Decoctum Taraxici, B. P., is administered in the 
dose of 2 to 4 ounces. 



TARTARIC ACID. 

Acidum Tartaricum, U. S. and B. P., is a vegetable acid much 
less powerful than acetic acid, but capable of producing very severe 



THALLIN. 285 

gastroenteritis if taken in overdose and in concentrated form. It 
is rarely used alone and is most commonly employed to act upon 
sodium or potassium bicarbonate to form effervescent drinks. (See 
Seidlitz Powder and Effervescing Draught.) 

When taken in poisonous dose, lime-water, alkalies, and magne- 
sium are the antidotes, and opium is to be given to allay irritation. 
If necessary, emetics are to be used. 



TEREBENE. 

Terebene is a liquid substance, clear and colorless, and insoluble in 
water, having a peculiar odor like that of new pine sawdust, and is 
made by the action of sulphuric acid upon oil of turpentine, which 
is then distilled at about 160° F. 

Therapeutics. — Terebene is a very useful stimulating expectorant,, 
to be used in the late stages of acute or chronic bronchitis to liquefy 
and get rid of the mucus which is clogging the bronchial tubes. It 
has also been employed in genito- urinary inflammations of a subacute 
or chronic form in place of oil of sandalwood or copaiba as a stim- 
ulant. In fermentative dyspepsia it is of service as an antiseptic. 
The drug should always be given in capsules in the dose of 5 to 
10 minims, or by dropping it on sugar. This dose may be repeated 
every three hours. Unfortunately it is very apt to irritate the stomach. 



THALLIN. 

Thallin is a synthetically prepared chemical compound otherwise 
known as parachinanisol. There are three salts of thallin, the sul- 
phate, the tartrate, and the hydrochlorate. All of them are alike in 
appearance and taste, but the sulphate is generally employed. Given 
to man in a healthy state they produce an unpleasant taste in the 
mouth, but no other symptoms unless the dose be quite large. 
Buzzing in the ears, labored respiration, deep cyanosis and coma 
come on after excessive amounts are taken. 

Physiological Action. Nervous System. — So far as is known, 
its influence over the nerves amounts to almost nothing. ISTo studies 
are on record of any such direct influence. 

Circulation. — Upon the circulation thallin has little influence 
in moderate dose, although its tendency is toward depression rather 
than stimulation. In very large doses it lowers blood-pressure by 
depressing the heart and peripheral vaso-motor system. 

Temperature. — Thallin reduces normal bodily temperature very 
slightly and lowers febrile temperature by increasing the dissipation 
of heat. 



286 DRUGS. 

Tissue-avaste and Urine. — It increases the urinary flow, but 
its action on tissue- waste is uncertain. 

Antiseptic Action. — It posseses more antiseptic powers than 
other antipyretics, and one per cent, solutions prevent fermentation 
for some time. 

Prolonged Poisoning'. — In prolonged poisoning the drug causes 
degenerative changes in the kidneys and decrease in the number of 
the red blood-corpuscles. 

Therapeutics. — Thallin has never obtained much hold upon pro- 
fessional favor for reasons not very easy to perceive. The studies of 
Minot seem, because of their American origin and care, worthy of 
special mention as in reality outlining the general opinion and 
thought of the practitioners on this side of the Atlantic in regard to 
this drug. Minot found that thallin acted more satisfactorily and with 
the most lasting effect when it was given at or just before the end of 
the fastigium. The effects of the drug were always most favorable, 
sweating and vomiting occurring but a few times, while in many 
instances the patient, previously restless and delirious, became tran- 
quil and quiet. It was also found by Minot that the drug exercises 
no appreciable influence upon the duration of the disease in typhoid 
fever, and he coucludes that it is sufficiently harmless to be given to 
very young children. 

The writer's experience with thallin is too limited to permit of his 
speaking authoritatively concerning it, and he can therefore merely 
state that it has always seemed to him far less useful in fevers than 
many of the other drugs of its class. The fact that its influence is so 
transient, only from two to three hours as a rule, the necessity of its 
frequent dosage in consequence, and its liability to nauseate the 
patient by reason of its taste and action on the stomach, are all against 
its use. That it acts quite as rapidly, if not more so than antipyrine 
and acetanilide, there can be no doubt. It has been found, too, that 
the sweat is often very excessive, although there are some observers 
who assert that, in children particularly, this symptom is often absent. 
Jaccoud thinks that so many people have an idiosyncrasy to its use 
that small doses should always be used at first. 

Owing to the transitory effects of the drug frequent administra- 
tion of the remedy is necessary, and as this was first pointed out by 
Ehrlich, the term " thallinization of Ehrlich" is frequently heard 
of at the present time when the drug is spoken of. The doses 
under these circumstances should be given hourly in the amount of 

o 1 grain, or even 2 grains in adults. 



THYMOL. 

Thymol, U. 8. and B. P., is derived from the oil of thyme and 
other volatile oils, and occurs in large crystals. Thymol is almost 



TOBACCO. 287 

insoluble in water, but freely so in fats aud oils. It is irritant, but 
autiseptic and disinfectant, aud has been employed in typhoid fever 
as an intestinal antiseptic by Heury and others. Thymol has been 
used for dressing wounds, but is too costly. In summer weather it 
cannot be used, because of its attraction to flies, which makes the 
patient's life miserable. The dose is J to 2 grains, in capsule or 
in wafer, followed by a glass of milk. In typhoid fever as much as 
30 grains in twenty-four hours may be given 

If very large amounts (100 grains) are taken in a day, poisoning 
may result, but as much as this must be used before danger is present. 



TOBACCO. 

Tabacum, U. S. (Tabacum Folia, B. P.), is the dried leaves of 
Nicotiana Tabacum, a native of tropical America, but cultivated all 
over the temperate zone. It contains a liquid alkaloid, nicotine, but 
does not contain nicotianin, as no such principle exists. 1 When 
smoked it yields pyridine, which is sometimes used in medicine by 
itself. 

Physiological Action. — Tobacco, in overdose, is a nauseating 
emetic, very depressant in its influence on respiration and the circu- 
lation. The pupils are contracted by its influence, the bodily tem- 
perature is lowered, and the skin becomes cold and clammy. 

Upon the motor nerves it acts as a depressant poison. 

Nicotine is one of the most violent poisons known, and is almost 
as fatal as hydrocyanic acid, death having taken place in three min- 
utes after the ingestion of a poisonous amount. 

The drug, when smoked or chewed to any extent by young per- 
sons, stunts the growth of all the parts, and is very apt to cause, in 
all persons, granular sore-throat, pharyngitis, laryngitis, and faucitis. 
Sometimes angina pectoris is developed. u Tobacco heart " is a term 
applied to a condition of this viscus, characterized by disorders in its 
rhythm or power; palpitation, arhythmia, and dyspnoea being often 
present. 

The treatment of poisoning consists in the use of strychnine to 
stimulate the nervous system and the respiratory centre, cardiac 
stimulants, external heat, and atropine. 

In the mild form of poisoning, following excessive smoking, in 
which slight nausea is felt, the author has found 1 to 2 drachms 
of Hoffmann's Anodyne taken in ice- water most effective. 

Therapeutics. — Tobacco is used to relieve constipation by some 
practitioners, and for this purpose the wine ( Vinum Tabaci) is 
usually employed in the dose of 10 minims every night on retiring 

1 See author's Prize Essay on Tobacco. Philadelphia, 1885. 



288 DRUGS. 

to bed. The drug has been employed in many affections, such as 
asthma, intestinal obstruction, and dropsy, but has passed into disuse 
because the symptoms often produced were excessively severe and 
very serious to the patient. Applied in solution to pruritus ani and 
vulvce it is often of service, but absorption may occur and produce 
untoward effects. It ought not to be used on piles for this reason. 



TURPENTINE. 

Terebinthina, U. S., occurs in two forms, namely, as turpentine 
derived from the ordinary yellow pine (Pinus Australis) and other 
varieties of pine, and as turpentine derived from Abies Balsamea, or 
Silver Fir, or other species of cone-bearing trees than Pinus Aus- 
tralis. The latter is sometimes called "Balm of Gilead." 

Much confusion often exists in students' minds as to the difference 
between oil of turpentine {Oleum Terebinthince, U. S. and B. P.) 
and spirit of turpentine, both of which are identically the same 
substance under a varying name. This oil is not, however, the same 
thing as "turpentine," for the oil is distilled from turpentine. The 
distilled oil is a thin, clear fluid, having a peculiar odor and taste, 
and is irritant to the skin and mucous membranes. It is exceedingly 
inflammable, should never be placed near a light, and if added 
to any strong mineral acid takes fire. 

Physiological Action. — Turpentine, when taken internally, pro- 
duces a sense of warmth in the stomach, a quickened pulse, a warm 
skin, and slightly accelerated breathing. In overdose it may cause 
intoxication. Upon the circulation it produces a very slight rise of 
arterial pressure, increased pulse-rate, and increased heart-force. On 
the nervous system the drug causes, in large amounts, loss of sensa- 
tion before voluntary motion. 

The drug is eliminated by the kidneys and lungs, and gives the 
odor of violets to the urine. 

Poisonous doses cause strangury, bloody urine, renal inflamma- 
tion, and cyanosis, with dilated pupils and gastro-enteritis. 

Therapeutics. — External use. Turpentine is used as a local ap- 
plication for the purpose of producing counter-irritation over any 
area where deep-seated inflammation exists. Under these circum- 
stances it is almost always used in the form of a stupe, made as fol- 
lows : Place a tin cup containing the turpentine in a vessel contain- 
ing hot water so that the turpentine may be warmed without coming 
near a flame. Dip a piece of flannel into very hot water and wring 
it out in a twisted towel, and, when it is so dry that no water drips 
from it, dip it into the hot turpentine and wring it out again to free 
it from any excess of the drug. The cloth, while hot, should be 
locally applied, and allowed to remain until discomfort ensues, when 



TUKPENTINE. 289 

it should be withdrawn, as it will blister if left on too long. In 
children and adults turpentine may be rubbed on the chest in bron- 
chitis with much relief, but in the former class it should be diluted 
with sweet oil, half and half or even two-thirds. 

Internal Use. — Turpentine is used internally as a stimulant of a 
diffusible type in the course of the exhausting fevers, particularly if 
any flatulence exists or if any ulceration of the bowels is present. In 
typhoid fever turpentine stupes, turpentine enemata, and the adminis- 
tration of the drug by the mouth, are the best ways to overcome 
tympanites. At the end of the second week, when the tongue is 
red, dry, cracked and brown, the teeth covered with sordes, and 
tympauy is well marked, turpentine should be used in emulsion in 
the dose of 5 to 10 drops three times a day. Again, in convales- 
cence from typhoid fever, when diarrhoea is persistent and relapses 
are constant and due to the unhealed state of Peyer's patches, tur- 
pentine is the remedy par excellence. 

In intestinal and other passive hemorrhages, such as Menorrhagia, 
the drug is often of service. 

Used against the tapeworm turpentine is given in the dose of half 
an ounce to an ounce mixed with an equal amount of castor oil. 
This is a somewhat dangerous practice, but is efficient. In chronic 
and well-advanced kidney disease it often requires very large doses 
of diuretics to stimulate the kidneys sufficiently to cause urinary 
flow, and turpentine may then be employed. 

Turpentine is contra-indicated in any acute inflammation of the 
g astro-intestinal tract and in nephritis. 

In lumbago 20 drops are said to be very useful and many have 
found it of value when inhaled from boiling water in bronchitis of a 
subacute or chronic form. In gleet it is given by the mouth to 
stimulate the genito-urinary tract. Turpentine should be tried in 
purpura hemorrhagica as it has been found of value. 

Administration. — Turpentine may be given in flatulence by plac- 
ing 5 drops on a piece of sugar or in emulsion made by using acacia 
and a flavoring substance as follows : 

Be — 01. cinnamomi ....... gtt. xx. 

01. terebinthinae ...... f>pv. 

INIucilag. acacise . . . . . q. s. f Jiv. 

M. — S. A teaspoonful every four hours in typhoid fever. 

A more agreeable preparation, not to be used in typhoid fever, is 
that recommended by Bartholow as follows : 

R. — Olei terebinthinse f%j. 

Olei amygdal. expres. . . . . . f^ss. 

Tine, opii f ^ ij . 

Muci-1. acaciae f.^v. 

Aq. lauro-cerasi f'^ s s. 

M. — S. A teaspoonful every four hours for tympanites. 

19 



290 DRUGS. 

When used as an enema the following is useful : 

K. — Olei terebinthinse f^j. 

Olei olivse ........ f^jss. 

Camphorse ........ gr. xx. 

Mucil. acaciae . . . . . . . f^ss. 

Aq fgx. 

M. — S. To be injected as an enema for tympanites and to aid in the removal 
of hardened fceces. 

The liniment (Linimentum Terebinthince, U. 8. and B. P.) is 
largely used as a stimulating application to sprains and enlarged 
joints. 

Turpentine is of service in ring-worm, applied with a brush to the 
part affected. The following preparations are officinal in the B. P. : 
Oonfectio Terebinthince, dose 1 to 2 drachms, Enema Terebinthince, 
Unguentum Terebinthince, and Linimentum Terebinthince Aceticum, 

The ointment is used as a counter-irritant and stimulant to the 
part to which it is applied. The liniment acts in the same way when 
applied to sprains and bruises. 



UVA URSI. 

Uva Ursi, U. 8., Bear berry, is the leaves of Arctostaphylos TJva 
Ursi, a widely distributed evergreen shrub. This drug is known in 
the B. P. as Uvce Ursi Folia. Its active principle is arbutin, some- 
times called ursin. 

Therapeutics. — Uva ursi is employed in medicine as a weak, astrin- 
gent diuretic possessing alterative power over the genito-urinary 
apparatus. It is used in pyelitis, cystitis, and in chronic gonorrhoea 
or gleet. When taken in overdose it escapes from the body as hydro- 
chinone, making the urine dark colored or black. 

Administration. — Arbutin itself is often used in the close of 3 to 
5 grains. The dose of the fluid extract (Extraction Uvce Ursi Flui- 
dum, U. 8.) is 2 to 4 drachms three times a day. An infusion 
(Infusum Uvce Ursi) is officinal in the B. P., dose 1 to 2 ounces. 



VALERIAN. 

Valerian ( Valeriana, U. 8.) is the rhizome and rootlet of Valeriana 
officinalis, a plant of Europe but cultivated in America. It is offi- 
cinal in the B. P. as Valeriana Bhizoma. Its active principle is 
apparently a volatile oil (Oleum Valerianae). It also contains 
valerianic acid. 

Physiological Action. — Valerian is a very feeble depressant to the 
nervous system, tending to produce nervous rest, but in cats it ex- 



VERATRINA. 291 

cites to a great degree sexual activity, probably from its odor. When 
very large doses are given to man it causes a sense of warmth in the 
stomach, a slightly quickened pulse, and perhaps nausea and vom- 
iting. Still larger amounts produce purging and mental hebetude. 

Therapeutics.- — Valerian is used alone or in combination with 
other drugs to quiet nervous females and relieves nervousness and in- 
somnia. In hysteria it is often very serviceable, and combined with 
morphine is much used in the treatment of delirium tremens. 

Administration. — The fluid extract (Extr actum Valeriana? Flui- 
dum, U. $.),dose 1 fluidrachm, and the ammoniated tincture (Tinctura 
Valeriance Ammoniatce, U. S. and B. P.), dose 1 to 3 drachms, are 
the best preparations for ordinary use. The infusion, which is not 
officinal, is given in the dose of a wineglassful, while that of the 
simple tincture (Tinctura Valeriance, U. S. and B. P.) is 1 to 3 
drachms. The dose of the oil {Oleum Valeriance, U. S.) is 2 to 4 
drops. An infusion (Infusum Valeriance) is officinal in the B. P., 
in the dose of 1 to 2 ounces. 



VALERIANIC AOID. 

Acidum Valerianicum is an oily, colorless liquid of a strong odor 
and burning taste, but is not employed in medicine except in the 
form of its salts, such as the valerianate of zinc, iron, quinine, or 
ammonium, all of which are employed partly for their sedative effects 
and partly for their influence as tonics. 

The dose of Zinci Valerianas is J to 3 grains, that of Quinince 
Valerianas, U. S., 1 to 3 grains, of Ferri Valerianas 2 to 10 grains, 
and of Ammonii Valerianas 2 to 10 grains. Under the name of 
" the pill of the three valerianates" Goodell recommends the follow- 
ing in nervousness and hysteria : 

R. — Quininse valerianate \ 

Ferri valerianat. V . . . . aa gr. xx. 

Ammon. valerianat J 
M. — Ft. in pil. No. xx. S. One or two three times a day. 



VERATRINA. 

Veratrina, U. S. and B. P., is an alkaloid derived from Veratrum 
Sabadilla, and occurs in a grayish powder, which if it enters the nose 
produces violent sneezing which lasts for hours. 

Physiological Action. Nervous System. — Veratrine has little 
effect on the cerebrum, but it does excite the spinal cord and the 
voluntary muscles, thereby giving rise to tetanic or tonic convulsions, 



292 DRUGS. 

which are never clonic or epileptoid. The dominant action of the 
drug is paralytic and these nervous symptoms soon give place to 
paralysis. The muscles lose their contractile power and the nervous 
centres are depressed. 

Circulation. — In poisonous dose the heart is slowed by the 
drug, greatly weakened, and finally stopped in diastole, and is found 
after death to be soft and flabby. In smaller doses it at first slows 
the pulse by stimulating the peripheral inhibitory nerves and the 
centres in the medulla, but later these parts are paralyzed. It first 
stimulates the vaso- motor centre, then paralyzes it. 

Respiration. — The drug kills by failure of respiration due to 
paralysis of the respiratory centres. 

Temperature. — Veratrine always causes a fall of bodily heat. 

Poisoning. — The symptoms of poisoning in man are collapse, a 
pale, cold, wet skin, pinched features, and a rapid, thready pulse, 
accompanied by violent vomiting and muscular tremors. Tetanic 
convulsions may come on and resemble those of strychnine in that 
they arise from the slightest touch or draught of air ; after death the 
muscles will be found to have lost their irritability. 

Therapeutics. — Veratrine is never used internally. It is employed 
chiefly in the form of an ointment rubbed into the skin over mus- 
cular rheumatism and rheumatic joints, and over neuralgic nerves. 
The officinal ointment ( TJnguentum Veratrina?, U. 8. and B. P.), or 
the oleate (Oleatum Veratrince, U. 8.), should be used, the latter most 
carefully, as absorbtion of the drug may take place in sufficient quan- 
tity to poison the patient. 



VERATRUM VIRIDE. 

Veratrum Viride, U. 8., Indian Poke, Poke Root, or Swamp Hel- 
lebore, is an American plant largely used for the purpose of allaying 
inflammation ; it is officinal in the B. P. under the name of Veratri 
Viridis Rhizoma. 

It probably contains a number of principles, the chief of which 
are, however, jervine and veratroidine. 

Veratrum viride is the safest and best circulatory depressant that 
we have for use in adults. 

Physiological Action. — The physiological action of this drug is to 
be considered under the effects of its two alkaloids before the com- 
plete effect is studied. 

Jervine. 

When Jervine is given in full toxic dose it causes great slowness 
of movement, relaxation of the muscles, through which thrills con- 



VERATROIDINE. 293 

tinually run, and finally the animal falls to the ground. Violent 
epileptiform convulsions may now ensue, but no tetanus is present. 
The convulsions soon give place to paralysis and are characterized 
by their lack of force. Sensation is not affected until the near ap- 
proach of death brings on anaesthesia. There is no evidence of 
gastro-enteritis and no vomiting or purging. The saliva is always 
increased and pours from the mouth. Death results by failure of 
the respiratory centres and an almost simultaneous failure of the 
heart. The circulation is greatly depressed and the pulse-rate and 
force are far below their normal rate and strength. 

The blood pressure is very low except when the convulsion pro- 
duces a temporary rise, but the condition of the vaso-motor centre and 
vagi is apparently normal. Jervine acts as a direct depressant to the 
vaso-motor centres. The convulsions are due to the disturbance of 
the circulation at the base of the brain (Wood), and the spinal cord is 
directly depressed by the effect of the jervine on its motor tracts. 



Veratroidine. 

This alkaloid is much more irritating than jervine, and in over- 
dose causes vomiting and purging. The muscular twitchings and 
convulsions caused by jervine are also produced by it, but are gen- 
erally not so severe. It also depresses the spinal cord in its motor 
tracts. 

On the circulation veratroidine slows the pulse by stimulating the 
pneumogastric centres, and finally quickens it if given in very large 
doses, by paralyzing the peripheral vagi. 

The following summary given by Wood of the circulatory effect 
of veratrum viride, from a study of its alkaloids, is so brief aud terse 
as to be worth insertion here : " Veratrum viride slows the pulse by 
a direct depressant action on the heart muscle (jervine), and by stim- 
ulating the pneumogastric nerves (veratroidine); it lowers blood pres- 
sure by action on the heart muscle (jervine) and by depression of the 
vaso-motor centre (jervine)." 

Poisoning". — Veratrum Viride, while one of the most powerful 
drugs we have, is one of the least dangerous, since it almost invariably 
causes vomiting before enough of the drug is absorbed to produce 
serious consequences. The vomiting is partly due to the veratroidine 
and partly to an irritant resin. In poisoning cardiac stimulants, 
atropine, external heat, the placing of the head below the feet on an 
inclined plane, and the use of strychnine as a respiratory and nervous 
stimulant are to be resorted to. 

Therapeutics. — The chief use of veratrum viride is as a circulatory 
sedative in acute, sthenic, or dynamic inflammations. 



294 DRUGS 

In pneumonia, pleurisy , acute hepatitis, peritonitis, and cerebritis it is 
of the greatest value if given at the proper stage when only conges- 
tion or hyperemia is present. After the onset of the lesions follow- 
ing this period, its use is not only valueless but malpractice. Owing 
to its physiological influence it bleeds a man into his own blood- 
vessels, and the indications for its use are the same in inflammation 
as they would be for bleeding. In puerperal fever it has been highly 
recommended but must be most carefully employed. It is also of 
value in excessive cardiac hypertrophy and in the irritable heart of 
strong healthy men. In aneurism where the circulatory disturbance 
is great and the arterial pressure high, the drug may be used, with 
great care, to decrease the pressure and prevent rupture of the diseased 
vessel. 

Contra-indications. — Veratrum viride is contra-indicated in 
all conditions of depression or exhaustion, and if vomiting is feared, 
must not be given in peritonitis or gastritis as it may cause emesis, 
and in this way disturb and irritate the abdominal contents.; 

Administration. — The doses in inflammation should be given every 
half hour or hour and at least 1 drop of the tincture should be used 
each time in a healthy adult. In the course of two or three hours, 
or less, the skin becomes moist and relaxed, the pulse slower and less 
angry, and slight nausea may be present. These symptoms show 
that the drug is exerting its influence and it should now be with- 
drawn, or in very sthenic cases pushed a little farther. If vomiting 
comes on before the drug has acted on the circulation, 5 to 10 drops 
of laudanum should be given 15 minutes before each dose of vera- 
trum viride. The best preparation to employ is the tincture ( Tinctura 
Veratri Viridis, JJ. 8. and B. P.), dose 1 to 3 drops, and the fluid 
extract (Extr actum Veratri Viridis, U. 8.) 3 to 6 drops. Under the 
name of Norwood's tincture, a saturated tincture has been sold. It 
is not officinal and ought never to be used. 



VIENNA PASTE. 

Potassa cum Calce, U. 8., is a milder and more manageable eschar- 
otic than is caustic potash, and is used for the same purposes. (See 
Caustic Potash.) 

WARBURG'S TINCTURE. 

Warburg's Tincture is a complex liquid formed by the mixing 
together of no less than thirteen ingredients. Its inventor, Dr. War- 
burg, held its composition as a secret for a time, but finally made it 
public. Since he published the original formula it has been con- 
siderably altered, and some of the preparations now sold as War- 



zinc. 295 

burg's tincture contain none of the original ingredients. Further 
than this some of these ingredients are now not obtainable. It 
ought to be made as follows, if possible : 

I£. — Aqueous extract of aloes .... 28 grains. 

Rhubarb 448 " 

Angelica seed 448 " 

Elecampane 224 " 

Saffron 224 " 

Fennel 224 " 

Gentian 112 " 

Zedoary root 112 " 

Cubeb 112 " 

Myrrh . 112 " 

White agaric ....... 112 " 

Camphor 112 " 

Sulphate of Quinine 1280 " 

Dilute alcohol enough to make 8 pints. 

The coarse vegetable portions of this list are to be ground into a 
coarse powder, and the myrrh and camphor, which have been pre- 
viously pulverized, added to them. The entire mass, less the quinine, 
is then digested for 12 hours in a well covered vessel, on a water 
bath, the alcohol being prevented from evaporating as much as pos- 
sible. The liquid is now to be strained under pressure and the sul- 
phate of quinine added and dissolved. 

Therapeutics. — Warburg's tincture, next to pilocarpine, is the most 
powerful sweat producer that we have, and possesses in addition very 
remarkable anti-malarial power. In this last respect, it far exceeds 
quinine as a remedy in pernicious malarial regions for acute attacks 
and as a prophylactic. Its advantages over quinine rest in its favor- 
able action where congestions accompany the paroxysm. 

Administration. — To be of any value, Warburg's tincture should 
be given according to the following rules: The bowels of the patient 
should be first opened thoroughly by a saline purge, J an ounce of the 
tincture being given in one dose undiluted and no drink being taken. 
After the lapse of two or three hours a second J ounce is given in 
the same way, and very shortly a profuse sweat appears, which gene- 
rally marks the crisis of the disease, and recovery soon takes place. 



ZINC. 

Ztncum is not employed in medicine in its metallic form but as 
several of its salts, of which there are a large number, each of which 
will be found under the names of the acids forming them. 

Physiological Action. — Nearly all the salts of zinc are somewhat 
astringent, and when taken internally act as depressants to the ner- 
vous system. Some of them are more irritating than others, such as 



296 DRUGS. 

the chloride and sulphate, whereas the valerianate has almost no 
power except so far as the valerian is concerned. 

All of the salts in excess produce organic changes in the nervous 
system, generally represented by a myelitis, which, in the case of lead, 
is ascending, but in that of zinc transverse. 

The drug is eliminated by the liver and kidneys. Chronic poison- 
ing among workers in zinc is rare but has occurred. The symptoms 
closely resemble those of chronic lead-poisoning. 



PART III. 

REMEDIAL MEASURES OTHER THAN DRUGS, AND 
FOODS FOR THE SICK. 



ACUPUNCTURE. 

This is a term applied to the insertion of a small pointed instru- 
ment into the tissues in any part of the body for the purpose of re- 
lieving pain, swelling, or dropsies. When used in painful affections 
it accomplishes its best results in lumbago and sciatica, particularly 
in the former. In lumbago the writer takes two darning needles, 
places them in boiling water to render them aseptic, and inserts them 
into the affected muscles upou both sides, one to one and a half 
inches and allows them to remain in place for several minutes. They 
are then slowly withdrawn, care being taken to prevent them from 
breaking off. Often the patient can at once move more freely to 
his great delight. Ringer has, with his usual clear clinical sight, 
noted that this treatment is more successful in those who have 
bilateral pain than in those cases who have one side affected, and 
the writer has found this statement invariably true. 

In sciatica acupuncture is less successful than in lumbago, but is 
always to be tried. The needle should be carried down until it 
reaches the nerve, and, perhaps, pierces its sheath, and it must be 
absolutely aseptic. Bartholow has recommended the use of a hypo- 
dermic needle and the simultaneous injection of a few minims of 
chloroform or morphine. Sometimes the best results are reached 
from inserting the needle immediately below where the nerve finds 
exit from the pelvis. In other cases it is asserted that the insertion of 
a needle, over a corresponding spot to that which is sore, on the sound 
side may do good. Acupuncture is useless in acute rheumatism and 
lumbar pain produced by fevers. 

Sometimes a rhigolene spray may be used to freeze the skin over 
the parts with advantage in lumbago or sciatica. 

Acupuncture is occasionally resorted to for the relief of dropsy, but 
it is not commonly so employed, although it is often a useful measure. 
When the limbs become so tense with the effusion as to endanger 



298 REMEDIAL MEASURES. 

the life of the skin the tension should be removed by incisions, not 
punctures, if saline purges fail or canuot be used. Punctures 
rapidly close and make hard spots, while incisions remain open and 
permit free drainage. Immediately after the incisions are made the 
parts are to be dressed with cotton previously saturated with boracic 
acid solution and dried, or by absorbent cotton sterilized by baking 
it in an oven. It is hardly necessary to point out that the incision 
must be made under antiseptic precautions. (See Antiseptics.) 



ANTISEPTICS. 

The term " Antiseptic," as generally used, does not necessarily 
imply the power to destroy pathogenic germs. Any substance which 
inhibits the growth of microorganisms, which destroys or render in- 
nocuous the poisonous products of their action upon the tissues of 
the body, or which retards or prevents the absorption of such pro- 
ducts, is properly termed antiseptic. Since germicides necessarily 
possess antiseptic attributes they should, strictly speaking, be classed 
with antiseptics ; in this portion of the work, however, only such 
drugs as are sufficiently innocuous to allow of their use in the human 
body or upon its surface will be considered. Some of these, as, for 
instance, carbolic acid and bichloride of mercury, are efficacious, 
solely from their germicidal properties. Others, and of this class 
iodoform is the most important and typical example, exert their in- 
fluence not upon the microorganisms but upon the toxic substances 
formed by these organisms. 

Of the long list of antiseptics which have within recent years re- 
ceived warm commendation at the hands of individual writers there 
are comparatively few which have retained the confidence of the 
profession after prolonged trial. Only these few well-proven drugs 
will be discussed in this article. 

Heading the list, and in its germicidal power far surpassing all 
others, is bichloride of mercury. Long since the researches of Koch 
have shown that this salt is efficacious as a germicide in dilution of 
1 to 50,000. He stated, however, that where albumin was present the 
bichloride was decomposed and rendered inert. The same change 
was observed when solutions were allowed to stand for some length 
of time, even when distilled water was used as a solvent. By the 
addition of either sodium chloride or a weak acid such decomposi- 
tion was prevented. 

From this it follows that under ordinary circumstances the solutions 
of bichloride should be freshly prepared, or, if it is desirable to keep 
them for a long time, a sufficient amount of sodium chloride should 
be added to prevent precipitation of the mercury salt. Koch ad- 
vised that as much salt should be added as would equal the weight 



ANTISEPTICS. 299 

of the sublimate. Other observers, however, have advised ten times 
this weight of sodium chloride. 

Since whenever bichloride solutions are used in wounds or in 
cavities of the body they are brought in contact with blood serum or 
other albumin-bearing substauces, care must be taken that the anti- 
septic powers of the mercury lotion are not destroyed by the decom- 
position of its active principle. The power of the solution may be 
preserved by using it in such large excess that the small amount of 
chemical change has practically no effect, or by combining with it, as 
stated above, an acid which will not in itself be unduly irritating to 
raw surfaces. This end is accomplished by tartaric acid. In mak- 
ing up a solution one part of bichloride and five parts of tartaric 
acid are added to as much water as is needed. Thus in making up 
a solution of 1 to a 1000, for surgical purposes, the following pre- 
scription may be employed : 

R. — Hydrarg. chlorid. corros. ..... gr. xv. 

Acid, tartaric. ....... 3J-gr. xv. 

Aq. dest Oij. 

Bichloride solutions are used in the strengths of 1 to 500, 1 to 1000, 
and 1 to 2000, in the treatment of ordinary wounds. For the irri- 
gation of large cavities solutions of a strength greater than 1 to 
10,000 should rarely be employed, and even these dilute lotions have, 
when used in the peritoneal cavity, given rise to toxic symptoms. 
The 1 to 2000 solution is the one generally employed for sterilizing 
wounds and irrigating during operations. The stronger solutions of 
1 to 500 or 1 to 1000 are used in cleaning the surface of the body. 

The ordinary method of preparing a surface of the body for opera- 
tion is as follows : The part is first thoroughly scrubbed with soap 
and warm water, is shaved, and is washed again as before. It is 
then cleansed with alcohol or ether, after which a scrubbing with 
bichloride solution of 1 to 500 should follow, and be continued for 
at least two minutes. If no surgical interference is indicated imme- 
diately, the whole operative region should be enveloped in towels 
wrung out in a solution of 1 to 500, or 1 to 1000, and kept thus 
protected until the surgeon is prepared to operate. The moment the 
skin is incised no lotion stronger than 1 to 2000 should be employed, 
or if the more powerful solutions are used they should immediately 
be flushed out with one of less strength. The dressings, unless some 
particular form is used, may consist of boiled, bleached, and sun-dried 
gauze soaked in a 1 to 500 bichloride solution, and subsequently 
washed and wrung out in a 1 to 3000 dilution of the same antiseptic. 

Next in order of importance and in efficacy, among the antiseptic 
preparations, are carbolic acid and its solutions. The particular value 
of this drug lies in the fact that its potency is equally developed in 
both albuminous and non-albuminous solutions. Like the mercury 
salts its great disadvantage lies in its toxic properties. It is usually 



300 REMEDIAL MEASURES. 

used in solutions of 1 to 20 and 1 to 40. The carbolic acid of com- 
merce is found iu a liquid form, dissolved in alcohol, and represents 
a strength of about 95 per cent. In making the solution for 
surgical purposes an ounce of this liquid is added to 20 or 40 
ounces of water according to the strength of the solution desired. 
Although carbolic acid is soluble in fifteen parts of water, this solu- 
tion does not take place immediately, and in making solutions of a 
strength of 1 to 20, either the water must be hot, or a certain amount 
of time and considerable agitation of the mixture are required, other- 
wise globules of almost pure carbolic acid are deposited in the bottom 
of the tray or vessel into which the solution is poured, and these, 
by coming in contact with instruments or with the hands of the ope- 
rator exert an undesirable cauterant effect. 

The 1 to 20 solution is used for the disinfection of instruments and 
the cleansing of surfaces. For half an hour before an operation it is 
customary to submerge all instruments which will be required in a 
solution of this strength; when the surgeon is ready to use these 
instruments the solution is diluted to 1 to 40 by the addition of an 
equal volume of water which has been boiled. If a carbolic lotion is 
employed for irrigation, or for cleansing sponges during an operation, 
it should not be stronger than 1 to 40. 

A property possessed by carbolic acid, which renders it an un- 
safe medium for the impregnation of gauze, is its volatility. After 
an exposure of a few hours to the atmosphere it entirely evaporates, 
leaving not an antiseptic but simply a sterile dressing. This fact 
is utilized by the surgeon in the preparation of the deeper layers 
of the dressing, which come in immediate contact with the lips of 
the wound. Since all antiseptics are more or less irritating to raw 
surfaces, healing will be promoted by a sterile rather than by an an- 
tiseptic application. By moistening a piece of boiled and sun-dried 
gauze sufficiently large to cover the wound edges in a carbolic solu- 
tion 1 to 20, the asepticity of this dressing is assured; in a very few 
hours the heat of the body causes the entire evaporation of all the 
carbolic acid, leaving a sterile, non -irritating surface in contact with 
the wound. If protective is used or oiled silk is applied beneath the 
dressing, these materials should be treated with carbolic acid in the 
same way. 

In addition to its toxic effect upon the patient, carbolic acid greatly 
irritates the hands of the surgeon, and if used in a strength of more 
than 1 to 40 causes so much benumbing of tactile sensibility that mani- 
pulative skill is seriously interferred with. The cracked and fissured 
fingers resulting from the use of carbolic lotions are familiar to all, 
and at times produce results of far more serious import than tempo- 
rary pain and discomfort ; many recesses are provided in the depths 
of which septic germs may successfully resist the action of antiseptic 
washes. There can be no question that septic poisoning has been 
frequently due to this fact. 



ANTISEPTICS. 301 

Iodoform occupies a unique place among antiseptics in having been 
almost universally accepted and used by surgeons and clinicians in 
spite of the fact that its germicidal action was well proven by labora- 
tory research to be practically nil. It was found that nearly all 
forms of pathogenic germs grew abundantly upon culture materials, 
the greater part of which was made up of iodoform, and that injec- 
tions of such germs, mingled with large quantities of iodoform, pro- 
duced the characteristic effect upon living tissues with almost as great 
certainty as though this drug had not been used; furthermore, it 
was shown that iodoform was not even sterile, and that as employed 
by surgeons it was frequently a cause of infecting previously aseptic 
wounds. 

In spite of this overwhelming evidence against it the drug steadily 
grew in favor. Recent researches have explained, in part at least, 
the reason for this contradiction between experimental and practical 
results. It has been well said that the human body is not a test- 
tube, and that bacteriological research cannot supplant the evidence 
of clinical observation. Elaborate investigation showed that this 
drug acted as a powerful antiseptic, not by destroying the germs but 
by undergoing a decomposition in their presence, the products of 
which render the ptomaines, the result of germ growth, inert. In 
this way suppuration is, to a certain extent, inhibited, or, if present, 
its disastrous effects upon the system at large are prevented since 
these are due to ptomaine absorption rather than to direct effect of 
the microorganisms themselves. It has been apparently well proven 
that ptomaines, in themselves and without the presence of micro- 
organisms, can generate pus, but that where such ptomaines are 
mixed with iodoform before injection no pus is formed. If these 
septic chemical compounds are rendered inert a powerful adjuvant 
to the destructive action of the germ upon living cells is removed, 
and thus the system is often enabled to overcome one enemy where 
two would have prevailed. The fact that iodoform is in itself not 
sterile is, from a practical standpoint, most important. Fortunately, 
sterilization is readily accomplished. A thorough washing in a 1 to 
1000 bichloride solution destroys all microorganisms, and the powder 
may then be used without fear of producing infection. 

It will be readily understood from the foregoing that iodoform is 
of little service in aseptic wounds ; that it becomes of utility in direct 
proportion to the foulness of discharge, and that to exert its influ- 
ence it must be applied directly to the part. It is liable, in sup- 
purating wounds, to form a hard crust with the discharges, thus 
frustrating one of the most important indications in antiseptic sur- 
gery, i. e., drainage. Particular care should be exerted to see that 
the wound's secretion has a free exit. 

As employed in surgery iodoform, after having been sterilized, is 
placed in small pill boxes or wide-mouthed jars, over the opening of 



302 REMEDIAL MEASURES. 

which is tied a single layer of antiseptic gauze ; through this the 
iodoform is sprinkled, as desired, over wound surfaces. 

Kreolin, or Creoline, a preparation obtained from English coal by 
dry distillation, has been steadily and rapidly growing in popular 
favor, and bids fair to rival carbolic acid. In addition to its 
powerful germicidal effect it is non-irritant and practically non- 
toxic. The claim iirst advanced that this preparation was absolutely 
non-poisonous can no longer be supported, since cases have been 
reported where toxic symptoms have followed its use; these were 
probably due to individual idiosyncrasy, a factor which we can 
never hope to overcome entirely. It is certainly true that kreolin 
is the least poisonous of all the powerful antiseptics heretofore used. 
As an added advantage, in place of the harsh irritating effect pro- 
duced upon surfaces by carbolic acid solutions kreolin exerts an 
influence very like that of an oily or mucilaginous preparation. 

The extravagant claims advanced for kreolin in regard to its 
germicidal property have not been confirmed by bacteriological in- 
vestigation. In solutions containing albumin it is not efficient as a 
germicide in strengths of less than 1 to 100, its power being some- 
what below that of carbolic acid ; since, however, its toxic properties 
are much less marked than in the case of the latter drug, it can be 
safely used in stronger mixtures and, therefore, for practical pur- 
poses, its strength is greater. 

Kreolin, though insoluble in w^ater, readily forms an emulsion 
quite as efficacious in its antiseptic properties as a true solution. 
Since this emulsion is opaque it is scarcely applicable for immersing 
and sterilizing instruments, the latter not being readily found. It is 
admirably suited, however, for cleansing the hands, a five per cent, 
solution neither cracking the skin nor benumbiug the sensory nerves. 
In irrigating large wounds, cavities of the body, and particularly as 
a means of preventing sepsis or aborting it in gynaecological work, 
kreolin can be warmly commended. It may be employed in a 
strength of from 0.2 to 5 per cent. 

Barring the opacity of its emulsion in water it would be the 
medium, par excellence, for rendering instruments sterile and main- 
taining them in this condition during an operation. 

Among the many antiseptic agents of less importance may be 
mentioned peroxide of hydrogen. This drug comes in what is termed 
a fifteen volume solution. By this is meant that fifteen volumes of 
feebly combined oxygen are contained in each volume of the liquid. 
The few who have used it report remarkable results. It is applica- 
ble not to sterile surfaces, but to suppurating wounds and sinuses. 
It is alleged that peroxide of hydrogen immediately destroys the 
microorganisms of pus, converting, in one or two applications, a 
septic wound into one which is sterile and which will promptly heal. 
It is used in the strength of from 5 per cent, up to full concentration. 
Its disadvantages lie in the fact that it is expensive and that it 



ANTISEPTICS. 303 

readily undergoes decomposition. In this latter circumstance, pos- 
sibly, lies the explanation of its want of popularity, since the prepa- 
rations vary so greatly in strength that it is impossible to determine 
to what extent they should be diluted or what may be their potency 
when applied. (See Oxygen.) When this drug is poured into a 
suppurating sinus or cavity an ebullition takes place, which ceases 
only when the drug is exhausted or the infected surfaces are rendered 
sterile. With more extended trial the true value of this preparation 
will be determined. 

Chloride of zinc has been extensively employed in some clinics as 
an antiseptic application. It is used in 10 per cent, solutions and is 
applied when the field of operation is probably infected by pre- 
existing pus formation. Although bacteriological research has 
shown that this agent possesses feeble antiseptic power clinical expe- 
rience demonstrates its great value as applied to infected surfaces. 
Lately the sulpho-earbolate of zinc has to a great extent replaced the 
chloride as being less toxic and irritating and far more potent. 

For sterilization of mucous surfaces a saturated aqueous solution 
of boric acid is commonly employed. 

The increasing popularity of the latest dressing prepared by Lister, 
and its possession of qualities apparently superior to those of any 
other dressing yet described, make it desirable to give a brief de- 
scription of the method of preparation described in Lister's latest 
writing on this subject. " Cyanide of potassium, cyanide of mercury, 
and sulphate of zinc are mixed together in solution, in quantities 
proportioned to the atomic weights of 2KCy, HgCy 2 , and ZnSo 4 
-f 7H 2 0; the cyanide of potassium and cyanide of mercury being 
dissolved together in 1J ounces of water for every 100 grains of potas- 
sium cyanide, and added to the sulphate of zinc dissolved in three 
times that amount of water. The precipitate is collected in a strainer, 
and, when well drained is washed with two successive portions of water 
equal in quantity to that used for the solutions, namely, 6 ounces for 
every 100 grains of potassium cyanide, at least this amount of wash- 
ing being essential in order to free the precipitate sufficiently from 
the highly irritating soluble salts which are associated with it in its 
formation. The precipitate having thus been washed and drained, 
but not dried, it is thoroughly diffused with pestle and mortar in dis- 
tilled water (6 ounces for every 100 grains of potassium cyanide), 
containing in solution 1 part of hematoxylin for every 100 parts of 
the cyanide salt, the amount of which is known from the circum- 
stances that the dry product of cyanide salt is almost exactly equal 
in weight to the potassium cyanide employed. Hematoxylin is 
readily soluble in a small quantity of hot water, and remains in 
solution when added to a large quantity of cold water. The cyanide 
salt while it precipitates the hematoxylin, changes its color to a pale 
bluish tint. This is advantageously enhanced by the addition of a 
little ammonia to the mixture, in the proportion of one atom of am- 



304 REMEDIAL MEASURES. 

monia (NH 3 =17) to each atom of hematoxylin (C 16 H 14 6 3H 2 O 
=356). More thau this amount proves prejudicial. The ammonia 
is added in a dilute form, and it is convenient to have the dilution 
such that 1 fluidrachm of the ammoniacal liquid shall correspond 
with 1 grain of hematoxylin. The dye is further economized by 
allowing the ammoniated mixture to stand for three or four hours, 
and stirring it occasionally, so that the ingredients may react thor- 
oughly upon each other. If the mixture is filtered immediately, there 
is considerable loss of coloring matter. The dyed salt, having been 
drained and dried at a moderate heat, is levigated, and may then be 
kept for any length of time fit for use. When employed for charg- 
ing a dressing it is diffused by means of pestle and mortar in solution 
of bichloride of mercury (1 to 4000) in sufficient abundance to 
drench the fabric thoroughly, for which 4 imperial pints to 100 
grains of the salt will be found adequate. This will give a percent- 
age of between 2 and 3 of the cyanide to the dry gauze. The gauze 
should always be used moist;, and if it be prepared for immediate 
use, as by the dispenser of a hospital, the process of drying may be 
omitted ; the gauze, after being hung up for a while to drain, being 
deprived further of superfluous moisture by placing it for a while in 
a folded sheet. It may afterward be conveniently kept moist by 
wrapping it in a piece of mackintosh cloth. When obtained dry 
from the manufacturer, it should be moistened again with the weak 
corrosive sublimate solution before it is used." 

The advantages claimed for this dressing are that it is not irritat- 
ing to the skin, and that the antiseptic substance is not soluble, hence 
is not washed out by discharges. 

An omission of the details of cleansing the hands of the surgeon 
and assistants in preparing for an antiseptic operation is scarcely 
permissible in writing upon the subject of antisepsis. The most 
approved method is as follows : 

The hands and forearms are thoroughly brushed in hot soap suds 
for several minutes, after which the nails are carefully cleaned by a 
knife and brush, and the washing again repeated; the hands are then 
washed in alcohol for one minute, special attention being paid to the 
nails ; finally they are soaked for three minutes in a solution of bi- 
chloride (1 : 1000) and during the course of the operation are occa- 
sionally washed in a solution of the same strength. If it is neces- 
sary to lift a chair, to turn the patient, or to touch any object which 
has not been previously sterilized, the hands should be enveloped in 
towels wrung out in 1 to 1000 solution or immediately washed again. 



COLD AS A REMEDY. 

Cold, or the rapid abstraction of heat, is an appliance nearly 
always at hand and possessed of very great power for good in prop- 



COLD AS A REMEDY. 305 

erly selected cases. At the very first we may divide its use into its 
local application for a limited, deep-seated, or distant influence, and 
its general application for the purpose of affecting the entire body. 

When cold is applied for its limited and local action it is always 
used with two objects in view, namely, to cause localized contrac- 
tion of bloodvessels, which, through inflammation, are engorged so 
that the parts are reddened and swollen, or temporarily to anaesthe- 
tize or benumb a nerve fibre for the immediate relief of pain and 
with the hope that the temporary paralysis may result ultimately in 
such nerve changes as to produce a cure. 

For these reasons cold, in some form, is a popular remedy for a 
burn or sprain, or any injury likely to be followed by inflammatory 
processes. In some cases, it is true, hot water or dry heat is equally 
efficacious, and this fact will be referred to again when speaking of 
heat. (See Heat.) It may, however, be stated, as an almost inva- 
riable rule, that the choice of heat or cold is to be governed by the 
sensations of the patient, who will generally assert that one of the 
two is the more agreeable. 

Cold or heat causes relief of pain in inflammation by producing- 
contraction of the local bloodvessel walls. As a result inflamma- 
tory exudates do not occur, congestion is relieved, and as the pressure 
on the nerve filaments ceases the pulsating pain of inflammation 
passes away. 

A very useful remedy for the sprain of an ankle, when it is a 
recent accident, is to let the patient sit with the foot elevated, with a 
cloth wrung out in ice-water, or an ice-bag applied over the part 
affected. 

In the treatment of localized pain, cold is used in a number of 
ways, largely depending in their choice on the will of the physician 
and the wealth of the patient. The simplest, cheapest, and perhaps 
the most efficient method of using cold is to place cracked ice in a 
pig's or sheep's bladder, and after tying the opening to prevent leak- 
age, to lay it directly on the skin, surrounding it with a towel so as 
to prevent the moisture, which comes on the surface from condensation, 
from wetting the clothing. 

Where a very limited and comparatively transient effect is needed, 
it is customary in hospital and private practice to use a piece of ice 
sprinkled with a little fine salt, and held against the skin by means 
of a towel in the hand of the physician. Actual freezing can often 
be obtained in this manner very rapidly. 

Where a more rapid and elegant method is desired, sprays of var- 
ious very volatile liquids may be driven against the part by an 
atomizer. Probably the most readily employed of these liquids is 
ether, which is fairly effective if it is used in a fine spray and 
driven against the skin in such a way as to favor rapid evapora- 
tion. Another of these agents is rhigolene, w r hich is the lightest 
and most volatile of the liquid products of coal-tar, and is used in 

20 



306 REMEDIAL MEASURES. 

a spray from an atomizer in the same manner as is ether. Chlo- 
ride of methyl is a gas, which is very inflammable, of a sweetish 
smell and taste, and is used as a substitute for rhigolene as a local 
anaesthetic through the intense cold produced by its application. It 
is to be directed against the skin over the involved area by means of 
a tap attached to the cylinder containing the gas. 

It is hardly necessary for the writer to repeat that as all these last 
three applications are very inflammable, they should not be used near 
a light or fire. 

Aside from the local effects of cold on inflammatory processes it is 
largely resorted to for the relief of neuralgia of a superficial type and 
has often been used for rather deep-seated neuralgias, as over the 
course of the sciatic nerve in sciatica. Generally, however, it is em- 
ployed in neuralgia of the supra-orbital nerve where, owing to the 
superficial position of these fibres, the cold can readily penetrate. 
The skin should be distinctly whitened and blanched and even hard- 
ened by the cold before its application ceases, and if one application 
does not cause a cure it may be repeated every day for several weeks 
in obstinate cases. Sometimes cold is used to benumb the skin or 
subcutaneous tissues in cases where a minor surgical operation is to 
be performed, and is undoubtedly superior to cocaine where one 
wishes to open boils or small abscesses. It is also valuable when one 
is using the actual cautery, and in all these cases may be employed 
as is indicated above. 

The local employment of cold for the influencing of deeply-seated 
organs is not only a well-recognized therapeutic measure, but of 
great practical and physiological interest, and is so closely associated 
with the subject of counter-irritation as to be worthy of comparison 
with the article on that subject, before considering the subject as 
sufficiently studied to render its use clear. According to Winter- 
nitz, cold applied to the feet affects the cerebral circulation, cold to 
the thighs the circulation in the lungs, and cold to the back the 
circulation around about the pituitary region. Whether these asser- 
tions are true we do not positively know, but the fact that Winter- 
nitz has reached them by a series of experimental studies indicates 
their correctness to a great extent, and they also find additional sup- 
port in the popular and medical confidence in the use of cold to the 
head and heat to the feet in cerebral diseases. 

Practically cold has been employed with no small degree of success 
in the treatment of pneumonia and pleurisy in the form of the ice 
poultice or ice jacket. The only thing needful for such treatment is 
a condition of strength on the part of the patient, for it should not 
be used in adynamic cases. Where the ice poultice is used it is made 
by taking a mass of finely chopped ice, draining it of all water, and 
mixing it thoroughly with dry saw-dust, in sufficient quantity to 
absorb all the water derived from the ice as it melts. This is then 
basted into a quilt, so arranged that all of the contents will not sag 



COLD AS A REMEDY. 807 

to the lower border, and wrapped around the chest, being then well 
covered by a layer of oiled silk. Cold has also been highly recom- 
mended when used in pneumonia in another manner, and especially 
by no less prominent an authority than Niemeyer, who speaks of it 
as follows : 

" I have made extensive employment of cold in the treatment of 
pneumonia, and, relying upon a large number of very favorable 
results, can recommend this procedure. In all cases I cover the 
chest of the patient, and the affected side in particular, with cloths 
which have been dipped in cold water and wrung out. The com- 
presses must be repeated every five minutes. Unpleasant as this 
procedure is in almost all cases, yet even after a few hours the 
patients assure me that they feel a material relief. The pain, the 
dyspnoea, and often the frequency of the pulse are reduced. Some- 
times the temperature goes down an entire degree. My patients 
often retain this surprising condition of improvement throughout the 
entire duration of the attack, so that their outward symptoms would 
hardly lead one to imagine the grave internal disorder. The 
relatives of the patient, too, who do not fail to perceive the im- 
provement, now readily assist in the treatment to which at first they 
were opposed. In a few cases, and only in a few, the use of cold 
affords no relief, and the troublesome manipulation for its applica- 
tion increases the distress of the sufferers so much that they refuse 
to keep it up. In such cases I have not insisted upon the further 
application of cold. 

" In the hospital at Prague every case of pneumonia is treated with 
cold compresses, and, according to the statements of Smoler, it is ex- 
ceptional for a patient not to feel material relief from this treatment. 
I should only ascribe a palliative influence to their use, had not the 
duration of the disease in many instances been decidedly shortened 
and the convalescence hastened by means of their energetic and 
methodical employment. In fact, in but few cases have we seen the 
disease delay its departure until the seventh day. Many have 
improved on the fifth, and a very large number as early as the third 
day; nay, I have repeatedly found it impossible to keep patients 
with recent pneumonia in the hospital for a longer period than a 
week. Cold is rightly regarded as one of the most efficient anti- 
phlogistics in inflammation of external organs. Its action is directly 
tonic upon the relaxed tissues and dilated capillaries." 

The use of a cold bath, for the purpose of increasing the tone of the 
system, is as old a custom as any which we have, but like all other 
things in medicine cannot be used without distinct indications for its 
employment, or, to speak more correctly, the absence of certain contra- 
indications. The most universal exception to its use which we find 
is that class of persons with whom bathing of any kind, particularly 
when frequently repeated, does not agree. The writer is sure that 
a much larger number of persons belong to this class than is gener- 



308 REMEDIAL MEASURES. 

ally recognized, and he has seen cases of nervous exhaustion and 
general loss of vivacity and vitality occur as a result of too frequent 
bathing. This is the case more especially with daily bathers, who 
use cold or warm fresh water, particularly if the bath be taken in 
the morning. Before passing on to a consideration of the physio- 
logical action of a bath, and why and where we should use it, it is 
proper to call attention to the fact that a very large proportion of 
children w r ho are bathed daily are also allowed to lie and soak in the 
tub, and as a result become debilitated and fretful, only to recover 
when the bath is used once or twice a week, and replaced on the 
other days by a nightly sponging off with salt and whiskey or salt 
and water. 

Through practical experience and much experimental research of 
a more or less reliable character, we now know that the following 
phenomena accompany the use of a cold bath in a healthy person 
with whom such a bath agrees. 

On entering the water he shivers, thinks it almost unbearably cold, 
his teeth chatter, and he gasps if the cold suddenly touches the belly 
wall, or auy exposed surface. In a moment, however, reaction sets 
in, and the extremities heretofore blue, trembling, and covered with 
cutis anserina, become warmer and flushed. The pulse is increased 
in force and frequency, and the respirations are deeper and more 
thoroughly performed. As a result of this each portion of the body 
receives a more perfect supply of blood and feels rejuvenated. Fol- 
lowing this stage of exhilaration a third comes on in which the blue- 
ness and depression of the first stage recur in an exaggerated degree, 
but this condition does not ensue unless the person remains too long 
in the water. If he leaves the bath while in the acme of his exhila- 
ration, the stimulus may remain with him throughout the rest of 
the day. 

The reason for the occurrence of this train of symptoms is not 
far to seek. The chilliness of the first stage shows that the great 
abstraction of heat is lowering the bodily temperature, the centres 
for calorification in the body not manufacturing all the heat that is 
needed for the preservation of the normal temperature. At first 
the cold drives the blood hurrying into the warm recesses of the 
body, leaving the surface of the body cold ; but in a few mo- 
ments the system is aroused to the recognition of the fact that it 
must increase its exertions in the propulsion of blood and manufac- 
ture of heat, and so with an effort it puts forth all its pow T er, picks 
up each corpuscle that is hiding from the cold in the internal organs, 
and, after imbuing it with warmth obtained by increased heat-produc- 
tion in the sources of heat manufacture, forces it out to the surface of 
the body along with its fellows, which are driven to all parts of the 
system. This is not a mere figurative way of putting the matter, for 
cold always contracts bloodvessels and reflexly stimulates the vital 
centres to increased activity. 



COLD AS A REMEDY. 309 

When the bath is too prolonged the result of over-stimulation en- 
sues, and the depression of the nervous system and circulation is 
sufficiently severe to interfere greatly with normal functional activity. 

Just at this point it becomes clear why persons " catch cold " or, 
more technically speaking, are attacked by local or general conges- 
tions. One person who is weak may never reach the stage of stimu- 
lation, because his system has not enough units of force in it to bring 
them together and expend them upon the functional activities named, 
and, as a consequence, the blood, which at the first shock has hurried 
into the internal viscera, is not driven back to its duty, but sulking 
in its retreat like a deserting soldier allows disaster and disease to 
ensue because its superior officer, the central nervous system, cannot 
gather together enough force or authority to make it do its duty. 
These cases present evidences therefore of circulatory and systemic 
depression, or have congestion of the lungs, liver, or other parts. In 
the strong person exactly the same state of affairs obtains in the 
third stage of depression, but only after the strength of the system 
has been expended in the activity of the stage of exhilaration. 

Cold salt baths, particularly if they are sea baths, are more stimu- 
lating and not so relaxing as is fresh water bathing. 

Cold effusions to the head, or, better still, the use of an ice-bag, 
have long held a high position in the treatment of meningitis and 
head injuries, and a hot bottle to the feet, and cold to the head will 
often cause sleep in insomnia. This is particularly the case with 
those persons who have wakefulness from mental over-work. On 
the other hand, cases with insomnia from cerebral anaemia do well if 
a cold plunge bath is taken before going to bed, although in still other 
cases a hot bath is more efficacious. (See Heat.) The latter instances 
are not due to anaemia but to nervous irritability which the heat 
quiets, whereas, the insomnia of cerebral anaemia is relieved by a 
cold plunge by reason of the increased circulatory changes dependent 
upon the bath. 

The use of a cold bath after a person becomes heated is popularly 
supposed to be dangerous. On the contrary, every athlete knows 
that nothing is so refreshing and so preventive of muscular stiffness 
after severe exercise and sweating as a cold plunge or shower bath, 
but he also recognizes the fact that a plunge is all that is permissible, 
and it is only the person who posesses the healthy circulatory power 
which will enable him to rebound from momentary depression to 
increased activity that should resort to such procedures. 

Cold water dashed or sopped against the perineum or the scrotum 
and the lumbar region, is a favorite remedy for nocturnal seminal 
emissions with some practitioners, and the scrotum may be sub- 
merged in a tumbler of cold water for a few minutes at night for a 
similar purpose. 

A very useful treatment of dysentery is to inject gently into the 
rectum about one or two quarts of cold water; if necessary it may be 



310 EEMEDIAL MEASURES. 

icy cold, and a similar application for piles is a useful adjunct to all 
forms of treatment for these troublesome formations. 

So highly do some physicians praise this method, that the writer has 
thought it proper to quote from a paper of Dr. J. William White, 
Professor of Clinical Surgery in the University of Pennsylvania, 
upon this subject. He says: 

U I desire to call the attention of the profession to a method of 
treatment which, although not altogether new, is yet not appreciated 
as, in my judgment, it should be. I refer to a moderately forcible 
stream of water of varying temperature in the treatment of a number 
of affections of the rectum, anus, and genito-urinary apparatus. The 
atonic and astringent effect of such a stream of water upon any living 
tissue is, of course, a well-understood fact, and has been employed in 
the arrest of hemorrhage, in the treatment of inflammation, and in 
various conditions. But it has only been in exceptional cases, and 
usually by the aid of more or less troublesome apparatus that it 
has been used in the class of cases to which I now refer. 

" The bidet, as I have now for a few years prescribed it, should 
be of the variety which can be attached to the water-closet seat 
habitually used by the patient. It should have a nozzle capable of 
throwing a stream of about the calibre of an ordinary lead pencil or a 
little less. The head of water should be sufficient to make it im- 
pinge upon the parts exposed to it with enough force to excite there a 
little sensation of smarting or tingling. That degree of force will, 
for example, be sufficient to enable the patient to take an enema, or, 
if a female, to take a vaginal injection. The bidet pipe should be 
movable by means of a handle, so that the stream can be directed 
against any portion of the external genitals, the perineum, the anus, 
or the surrounding parts. It should also have connection with the 
hot and cold water supply of the house, so that the water may be 
used of any temperature which the physician may prescribe, or which 
the sensations of the patient may make desirable. Stop-cocks should 
regulate the size and force of the stream, and should be so placed as 
to be easily reached by the hand of the individual sitting upon the 
water-closet seat. Such an apparatus can be put in place by any ex- 
perienced plumber, in any ordinary water-closet, at an expense of 
from fifteen to twenty dollars ; and, in Philadelphia at least, the 
usual head of water obtainable even in third-story rooms is quite 
sufficient for all therapeutic purposes. 

" The cases in which it may be desirable to use this method of 
treatment may be divided into two classes : First, those affecting 
the lower end of the bowel and its outlet ; second, those involving 
the genito-urinary system. Among the first the most important are 
haemorrhoids, internal and external, prolapsus ani, and slight cases of 
prolapsus recti ; pruritus ani and eczema of the margin of the anus 
should also be included in this group of cases in which it has now 
for some time been my habit to prescribe the systematic employ- 



COLD AS A REMEDY. 311 

merit, twice daily, of the bidet, once immediately after the daily stool, 
and for the second time, by preference, just before going to bed. As 
a rule, in all the mid-winter months, the ordinary temperature of the 
Schuylkill water is that to be preferred, although I am largely governed 
by the feelings of the patient in this respect. An enema should be 
taken at each of these times, the lower portion of the rectum being 
thus thoroughly washed out at least twice daily, after which the 
stream of water is allowed to play upon the affected region for a 
period of from five to fifteen minutes. The ordinary and useful 
effect of cool sponging or washing immediately after stool in cases of 
haemorrhoids is by this means enormously increased. Internal haemor- 
rhoids will under this treatment, in many cases almost entirely dis- 
appear, unless they are exceedingly large and have been frequently 
inflamed or strangulated and badly neglected ; external haemorrhoids, 
even when fleshy, will shrivel and become scarcely noticeable. 

" I could detail a number of cases of this character taken from my 
practice of the last two years. In some instances in which I had 
been habitually called in, at intervals of a few months, in the case 
of old people the result has been practically their disappearance from 
my list of patients ; and they speak in the warmest manner of the 
great comfort derived from this simple method of treatment. 

" Perhaps nothing is more distressing among minor affections than 
the trouble described as pruritus ani, and variously attributed to 
liver disease, constipation, gastric troubles, latent gout, uterine disease,, 
parasites, neuroses, and a number of other causes, varying from eat- 
ing of shell fish, or excessive smoking, and to alleged hereditary pre- 
disposition. There are very few practitioners of any experience who 
have not discovered how difficult it is in any particular case of pru- 
ritus to assign distinctly the annoying symptoms to any one of these 
causes. Often the whole list may be carefully gone through and 
eliminated, or the proper remedies may be applied successively, as 
different theories are adopted without the slightest benefit resulting. 
Ointments, lotions, and ordinary cool bathing will be tried in great 
variety but without avail ; and such patients will often go from one 
physician to another, or fall into the hands of quacks while seeking 
relief My list of cases of this character, which I have now treated 
by means of the ' bidet/ comprises eight. 

" Nearly all my cases have resulted in cure ; requiring to attain 
that end simply different lengths of time of the application of the 
douche, with variations of the temperature of the water, and occasion- 
ally the use of some emollient salve. I have been particularly struck 
by the fact that these cases include among their supposed causes 
widely distinct conditions, and the uniformity with which they have 
yielded to this simple treatment has led me to regard with suspicion 
the orthodox etiology of the disease. In procidentia ani, and in 
slight cases of prolapsus recti, I have had very satisfactory though, 
of course, less striking results. In a few instances the trouble almost 



312 KEMEDIAL MEASURES. 

entirely disappeared, and in all of them it was distinctly relieved. 
These cases require for their successful treatment a much longer 
application of the douche, and the water should, in my judgment, be 
at one or the other extremes of temperature — either quite cool, or as 
hot as can be comfortably borne. 

" I am quite aware that the use of cold water in these affections 
is not in the least a novel plan of treatment ; but the method under 
consideration combines the effects of temperature with a sufficient 
force of the stream, and admits of the prolonged application of the 
remedy without effort on the part of the patient, who is in the most 
suitable position for this treatment, practical points which induced 
me to make this mention of my results in rectal and anal cases. 

"Agnew says of pruritus, that among the local remedies frequent 
ablutions with cold water should be mentioned ; and of prolapsus 
ani et recti, that ' in all cases where remedies have proved unavailing, 
or where patients have declined an operation, much good may be 
done by douching the parts with cold water and applying an oiled 
compress ;' and Allingham says of the same class of cases, that ' the 
frequent and bountiful application of cold water is to be most strongly 
recommended ; ' but few authors, so far as I know, have especially 
alluded to the method of application by means of a bidet. 

" My second class of cases includes, chiefly, certain prostatic 
troubles, varicocele, atonic impotence in the male, and pruritus of 
the vulva or vaginitis in the female. In cases of varicocele, although 
I have not succeeded in effecting a cure in any instance by this 
method, I have certainly seen advancing enlargements of the sper- 
matic veins becoming stationary ; long relaxed and pendulous scro- 
tums become firm and much smaller; and the mental condition of 
the patient, which is so important an element in many of these 
cases, share in the improvement. In chronic prostatitis, a most 
intractable and distressing ailment in many instances, it has come to 
be a part of my routine treatment to order the use of cold perineal 
douches by means of the bidet, associated with frequent cool enemata 
given in the same manner ; and I believe to-day that if I had to 
discard all therapeutic measures but one in these cases, I would 
retain this one. In a certain number of cases of impotence, associ- 
ated with general muscular weakness, loss of tone, lack of general 
strength and vitality, accompanied by imperfect or rapidly subsiding 
erections, I have found that the cold douche applied with some force 
and for considerable lengths of time to the perineum and testicles has 
been productive of marked benefit. 

u In two cases of pruritus vulvae my results have been good, 
though less striking than in similar disease affecting the region of 
the anus. In vaginitis, where the woman has sufficient intelligence 
to learn how to take an injection by means of the bidet, it offers an 
admirable method of cleansing the vagina, of carrying away thor- 
oughly all accumulated secretions, of reducing heat and swelling, 



COLD IN FEVERS. 313 

and at the same time of avoiding the frequent introduction into the 
inflamed canal of a foreign body in the shape of the nozzle of a 
syringe. My opportunities for observation in this class of cases 
have been limited, owing to the disinclination of these patients to 
procure the bidet and owing to their irregular habits of life and 
their frequent changes of residence ; but I have seen enough of its 
good results to make me feel confident that it is a valuable addition 
to our therapeutic agencies. 

" After all, in every one of the cases which I have mentioned, its 
use is simply the application of the most elementary and common- 
sense principles to every-day practice, but I am satisfied that this 
particular method of applying these principles has not received the 
attention which it merits." 



Cold in Fevers. 

The proper manner to employ cold in fever should be thoroughly 
understood. It may be used at a number of temperatures according 
to the effect desired, such as cool, moderately cold, and very cold. 

Very commonly in the course of a fever the patient is restless, 
uncomfortable and sleepless, yet has not a temperature fraught with 
any harm. Such a case may be sponged off with tepid water or 
with a little alcohol and water, or salt and whiskey, with great 
benefit in the production of sleep, the reduction of fever and the 
advantage of nervous quiet. Sometimes the sponging is successful 
when only used over the arms and legs, but more frequently it 
should be extended at least to the spinal column. 

If tepid sponging does not lower the fever in a given case, then 
ordinary cool tap-water should be employed, and it is well to remem- 
ber that the secret of successful sponging lies in the use of a sponge 
not saturated to overflowing but only sufficiently wet to leave a thin 
film of moisture on the skin which cools the patient by its rapid 
evaporation and does not wet the clothes and the bed. When cool 
water fails ice-water may be used, and a cloth wrung out in ice- 
water and several folds in thickness be laid over the chest and 
abdomen. When this is done this part of the body should be at 
first sponged with cold water to lessen the shock. It should be 
remembered, too, that cloths so applied become rapidly warmed by 
the heat of the body and should be constantly renewed. 

There are many cases where sponging even with ice-water fails to 
reduce the fever, and in these the fever must be lowered by the 
" cold pack," as it has been called. The name is unfortunate as it 
is indicative of a very severe exposure. The application is carried 
out as follows : 

A small canvas cot should be placed by the side of the bed of the 



314 REMEDIAL MEASURES. 

patient and covered by a large rubber cloth which, by being raised 
at the head and depressed at the foot, forms a channel for the water. 
Over this again is placed an ordinary sheet. The patient after 
being stripped is laid upon this sheet which is then folded over him 
and a fine spray from an ordinary watering-pot for flowers allowed 
to play upon the body from end to end. The temperature of the 
water depends upon the effect required. The bed should be so 
arranged that the water will not remain in puddles under the patient 
but drain off constantly into a bucket at the foot. The sheet being 
wet causes evaporation to go on and a rapid fall of fever results. 

During this procedure the thermometer should be placed in the 
mouth or deeply into the rectum, and the temperature watched. As 
soon as it reaches 101° or 100° F., the bath must cease, lest the fall 
continue and collapse ensue. 

On the removal of the patient the surface should be gently dried 
with towels, and the bed clothing consist of only a sheet, or a sheet 
and one blanket in cold weather. Above all things it must be re- 
membered that the patient is not to be wrapped up in a blanket, and 
not only this, but that he must not be placed in a blanket while still 
in the wet sheet. The wet sheet is only cooled by evaporation, and 
if surrounded by a blanket is a typical Russian or warm moist bath 
calculated to raise, instead of lower the fever. 

Where sunstroke (thermic fever) is present the patient may have 
chopped ice applied or be put directly into a bath-tub of ice water. 

The treatment of hyperpyrexia, due to rheumatism by cold, is 
quite as suitable as the treatment of other fevers whenever the hy- 
perpyrexia is so excessive as to endanger life. 

The presence of pneumonia and bronchitis does not seem to contra- 
indicate the use of cold in fevers, and no fear of u cold " being taken 
need exist, unless the bodily temperature is lowered below the normal 
point or to a few degrees above it. According to Liebermeister. 
intestinal hemorrhages contra-iudicate the use of cold, but this state- 
ment has been contradicted by no less a writer than Wunderlich. 



COUNTER-IRRITATION. 

Counter-irritation is a term applied to the use of substances irri- 
tating to the surface with which they come in contact, and employed 
for the purpose of influencing morbid processes in more or less dis- 
tant parts, or of affecting the general system. It has been thought 
that this method savors of the doctrine of " like cures like," but in 
reality it is based on sound physiological laws and is so logical as to 
have been described by the founder of homoeopathy as useless. 

The entire basis for the employment of counter-irritation rests 
upon reflex action or the conduction of a nervous impulse to a 



COUNTER-IRRITATION. 315 

centre which, when so stimulated, sends out an impulse to the part 
of the body which is diseased. 

The use of couuter-irritation may be divided into four parts or 
purposes. The first for affecting inflammations or congestions, the 
second for causing the absorption or removal of inflammatory deposits 
after true inflammation has ceased, while the third purpose is for 
the relief of pain, and the fourth for the effect which can be exercised 
upon the general system by blisters in systemic disease. 

In the same manuer that we can divide the iudicatious for counter- 
irritation iuto four parts so can we also divide its forms into three 
varieties according to their severity. The most severe are the caus- 
tics or escharotics, the next the epispastics or blisters, and finally the 
rubefacients or reddeners. 

The proper manner of employing a counter-irritant to affect in- 
flammations is not to apply it directly to an inflamed area, but a 
little to one side of it, or at a spot, kuown to be connected intimately 
with the diseased area by nerve fibres. 

Thus it is well known that in diseases of the eye the blister should 
be applied back of the ear, and that in abdominal neuralgia or in 
pleurodyuia the best results are reached, not from the application of 
a blister to the spot where the pain is felt, but to the poiut upon the 
vertebral column where the nerve at fault takes its exit. The reason 
for this is that pain is always referred to the peripheral end of an 
irritated nerve, and pleurodynia or abdominal pain often arises from 
vertebral disease or inflammation about the spiual ligaments or the 
foramina of exit for the nerves. In a similar manner we apply a 
blister sometimes in the early stages of hip-disease, not to the knee 
or ankle, where the pain is felt, but at the seat of the trouble, namely 
the hip. Counter-irritation is contra-indicated by the presence of 
any acute inflammation directly under the spot where it is proposed 
to place a blister. That is, if any reddening of the skin is present 
the blister or other form of irritation must not be applied there. If 
used at all it must be some little distance away or a series of small 
flying blisters placed around it. A flying blister is one which is 
small in area, say as large as a lima bean, and of comparatively 
slight action, healing rapidly after its effects have passed by. 

Among the inflammatory affections in which we find counter-irri- 
tation most serviceable may be mentioned pleurisy, pneumonia, iritis, 
synovitis, rheumatic or traumatic, cerebritis and peritonitis acute or 
chronic. A host of more subacute or chronic inflammations are 
also benefited by this measure, some of which are gleet, chronically 
enlarged joints, and inflamed glands. In all these states the blister or, 
more rarely, the rubefacient is to be resorted to, and while it is true 
that nearly all of these conditions are accompanied by fever and that 
fever is generally held to be a contra-indication to the use of counter- 
irritation, blisters undoubtedly do good at such times. In pneumonia 
or pleurisy along with the use of veratrum viride a cantharidal blister 



316 REMEDIAL MEASURES. 

of the size of a silver dollar should be applied Dear the spot where 
the most pain is felt or on the back near the spine. Where joints 
are inflamed, the blisters should be at some distance from the seat of 
the swelling, although it is often useful to place the counter-irritant 
on the inner or outer aspect of the knee-joint if the skin is not red- 
dened. In peritonitis the blisters are best applied directly over the 
seat of tenderness, and in cerebritis at the nape of the neck. In 
gleet a little cantharidal collodion may be painted along the under 
surface of the penis or upon the perineum with great advantage in 
obstinate cases 

Where inflammation is chronic and resists cantharidal blistering, 
then resort is often had to more severe forms of counter- irritation by 
means of the red hot, not white hot, iron, or the use of escharotics, 
such as caustic potash or soda, or arsenic. The reason for using 
these is that they all cause so much tissue-change in the part that the 
counter-irritation is very prolonged. Sometimes antimonial ointment 
is applied constantly, until a slough forms, to accomplish the same 
purposes. 

For the removal of the productions of inflammation we resort to 
cantharidal blisters or drugs possessing powers as local irritants and 
at the same time as alteratives. Thus in pleurisy with effusion it is 
very proper to employ a good sized cantharidal blister if the effusion 
has a tendency to remain unabsorbed. Some have thought that the 
absorption which follows is due to the abstraction of serum which 
takes place in the bleb formed, but this is a mistaken idea, as one 
often sees an effusion absorbed which far exceeds in quantity the 
amount of liquid in the blister. Under these circumstances the spot 
for applying the blister is generally immediately under the arm 
about two or three inches below the axilla. The blister, while it is 
useful in causing absorption in chronic effusions and deposits about 
joints, is not so good as are alterative irritants, for example, as iodine, 
which, in the form of a thorough application at one sitting, until 
the skin is black, not yellow or red, is often of service. In other 
cases, particularly in very chronic states, iodine ointment alone or 
with lard may be rubbed into the parts with advantage, care being 
taken to stop its use for a day or two as soon as the skin gets red. 
This same treatment is also useful in treating enlarged glands in the 
neck and elsewhere. 

One of the best treatments for epididymitis is to paint the scrotum 
black with many coatings of a strong solution of silver nitrate or 
iodine, to insist on total rest in bed, and to resort to the local use of 
cold. The testicles should also be supported during this treatment 
and aconite given if fever is present. 

For the relief of pain we very commonly resort to the rubefacients 
rather than epispastics, since the more moderate applications are 
equally effective in most instances and do not leave evil effects be- 
hind to remind the patient of his attack. 



COUNTER-IRRITATION. 317 

Every one who has had stomach-ache and remembers the relief 
obtained by the use of a mustard plaster or spice plaster, recognizes 
the value of this means of obtaining relief, and it only remains for 
the writer to state that headaches are ofteu amenable to similar treat- 
ment. These headaches may be neuralgic or due to dyspepsia or to 
cerebral anaemia or congestion, but counter-irritation will nevertheless 
do good. If neuralgic, a little menthol or oil of peppermint may be 
applied over the course of the nerve, which application, if the pain 
be supra-orbital, will require care lest the oil gain access to the eye. 

For the treatment of pain in the belly or chest or elsewhere we 
have four methods of applying counter-irritation in the shape of 
rubefacients. The first is mustard, the second, capsicum; the third, 
the spice poultice ; and the fourth, the turpentine stupe. 

The mustard plaster should be made by mixing mustard flour with 
warm vinegar or water, aud adding varying proportions of ordinary 
flour to modify its action. If the skin is tender, half mustard and 
half wheat flour may be employed, or, if a child is to be treated, the 
proportion may have to be one-fourth mustard. The plaster is made 
by placing a newspaper on a table and putting over it a piece of 
heavy muslin or linen. On this is smeared the mustard, and over 
the mustard mass is placed a more or less thin piece of linen, which 
prevents the poultice from adhering to the skin and modifies the 
burning according to its density. By folding the edges of the news- 
paper so that it resembles a picture frame we have at hand a cheap, 
effective and strong plaster, the back of which is supported by the 
newspaper. 

The spice plaster is made by mixing equal parts of allspice, cloves, 
cinnamon, nutmegs, and adding thereto one-half part of black pepper. 
These constituents are made into a homogeneous mass by using a knife- 
blade to mix them, and are then sewed up in a bag which is quilted 
to prevent sagging of the contents. One side of the poultice is now 
wet with warm brandy, whiskey, or vinegar, and applied to the part 
desired. 

If the skin is tender, the proportions of pepper aud cloves should 
be decreased. 

This plaster may be allowed to remain on the parts for hours or 
even days, and is very useful in gastric catarrh and indigestion, 
particularly that occurring in children. 

The turpentine stupe (see Turpentine) is not to be allowed to 
remain too long, as it may blister a tender skin, and the pepper 
plaster may be so active as to produce unbearable pain if it is not 
watched. 

The proper way of treating all such burns from counter-irritation 
is to apply simple cerate, cosmoline or sweet oil, to which may be 
added carbolic acid in the proportion of 1 to 100. The carbolic acid 
not only acts as an antiseptic but as a local anaesthetic, while the oil 
acts as a protective from contact with the air. 



318 REMEDIAL MEASURES. 

Much difference of opinion exists as to the proper treatment of the 
blister formed by cantharides. Where the blisters are small — that is, 
the size of the end of a finger — they may be allowed to break them- 
selves, and then dressed with dry cotton. If there are large blebs 
they should be punctured at their most dependent part with a needle 
and dressed with dry absorbent cotton, as by so doing the new skin 
forms rapidly underneath and is soon able to carry on its normal 
functions. 

The proper treatment of the blister while it is forming is to apply 
a poultice, which will decrease the pain and aid in the formation of 
the bleb. 

DISINFECTION. 

Before discussing the subject of disinfection we must turn our 
attention to what we mean by the terms employed when speaking of 
this subject in general. At present we recognize universally that the 
word germicide is a term applicable solely to agents capable of kill- 
ing the lower forms of life, whereas antiseptics are substances which 
simply render the material with which they come in contact so 
antagonistic or unsuited to germ development as to render their 
presence for any length of time impossible, at least in an active state. 
To use a simile, the killing of the inhabitants of a district by shoot- 
ing them would stop all growth and be germicidal, whereas the 
destruction of crops in these same parts would only be antiseptic ; or, 
in other words, the people might remain, but would either have to 
go elsewhere or starve to death. (See article on Antiseptics.) 

We now speak of germicides as disinfectants, but never of anti- 
septics as disinfectants, if we use these terms correctly. Germicide 
and disinfectant are therefore synonymous words. 

From what has just been said it is evident that we should always 
resort to disinfectants rather than antiseptics, for although the latter 
are good the former are better. 

We have three ways of destroying germs which are particularly 
useful. The first is the total destruction not only of the germs, but 
also of their resting-place, by means of fire, which may be used in 
the case of old furniture, mattresses and similar materials, and which 
may be extended to everything about the patient, if it is necessary 
to stamp out a brisk epidemic before it can get well under way. The 
second is the use of moist heat in the form of superheated steam, or, 
better still, for common purposes the use of boiling water; and, 
thirdly, by disinfectant materials which have a proved reliability. 

Moist heat in the form of superheated steam is infinitely prefer- 
able to dry heat, but as superheated steam cannot be readily obtained 
physicians usually direct the clothes to be boiled for at least two 
hours. 



DISINFECTION. 319 

Very often the bed-clothes are taken from a sick-room, trailed 
through the house, and finally deposited somewhere until a con- 
venient time for boiling them occurs. This is distinctly wrong 
and capable of causing a widespread distribution of the disease. In 
all such cases the bed-clothes should be rolled off the bed in a bundle 
and completely submerged in a bucket or tub of boiling water, or 
better still in a corrosive sublimate solution of the strength of 1 to 
1000, before they are taken from the room. This tub is now to be 
carried at once to the fire and the clothes lifted out dripping wet and 
plunged into a clothes boiler in which the water is actively boiling. 
The lid of the boiler is at once to be put on to increase the heat and 
prevent any germs escaping in the steam or in the hot air which 
arises from the surface of the water. The active boiling should be 
continued for one or two hours and water continually added to pre- 
vent scorching of the contents of the boiler. 

It is important that food be not cooked on the same stove at the 
time the clothes are being boiled, and no food should be in the room. 

If boiling cannot be used for any reason a 1 to 500 solution of cor- 
rosive sublimate may be tried or 1 to 20 of carbolic acid, although 
neither of these is so sure a method of disinfection. 

The proper care of a room after it has been occupied by a case of 
infectious disease is of great importance and is generally sadly 
mismanaged. Very commonly sulphur is burnt, and as commonly 
employed this is perfectly useless, owing to leaking windows and 
doors which permit most of the generated gas to escape. 

To be of any value the burning of sulphur must be preceded by 
packing the window cracks and door cracks with cotton or soft paper. 
The sulphur is then to be placed upon an iron pan under which 
is placed an alcohol or coal oil lamp. As the iron becomes heated 
the sulphur gives off its fumes. In other cases the broken rolled- 
sulphur is moistened with alcohol and lighted, but this is not so 
cheap or effective as the method first named. 

By far the best method is to take all movable objects out of doors 
in the fresh air and then wash the floor, sills, and casings, using 
a scrubbing brush, hot water, and soap. This water should after- 
ward be boiled to kill the germs which may be in it. After this is 
done the same surfaces should be scrubbed with a solution of corro- 
sive sublimate (1 to 500 or 1 to 1000), and left wet so that the salt of 
mercury may remain on them. Cracks and crannies are to receive 
particular attention. If corrosive sublimate cannot be used then 
carbolic acid (1 to 10 or 1 to 20) may be resorted to. 

By far the best disinfectant for all diseases is good ventilation. 
Not only should as much air as possible be allowed to enter the sick 
room, but after the case has vacated the premises the windows should 
remain open for weeks, if possible. Fresh air dilutes germs as fresh 
water dissolves or dilutes dirt. 

Disinfection of the discharges of ths patient is an important point 



320 REMEDIAL MEASURES. 

to be remembered. The urine and faeces should always be received 
in a vessel already containing enough corrosive sublimate solution 
(1 to 500) to kill all germs and to prevent their escape into the air or 
into water or food when thrown away. The disinfectant should be 
placed in the bed-pan before, not after, it is used. 

The bed-pan or chamber should not be allowed to stand in the 
room, but be removed and emptied at once in such a manner that it 
cannot contaminate any water or food. It should not be thrown 
upon the ground, as the air will dry it and cause the germs to fly in 
the form of dust anywhere and everywhere. In very contagious 
diseases bathing or swabbing off the patient with weak antiseptics 
may be tried. Thus 1 to 10,000 of bichloride of mercury may be used 
and the case wiped off with a wet towel. 

The question as to which are the best disinfectant substances is 
one which has attracted the attention of physicians and original in- 
vestigators for years. The result of a vast amount of study and 
experience shows that corrosive sublimate is the best of all disinfec- 
tants in the proportion of 1 to 250 to 1 to 500, or even weaker, and 
that for cheapness, activity, and general usefulness chlorinated lime 
is better still. The disadvantages in the use of corrosive sublimate 
lie in its ready decomposition, its formation of an albuminate w T hen 
albumen is present, its uselessness where lead pipes are present, and 
above all its expense. Chlorinated lime depends entirely upon its 
chlorine for any disinfectant power which it may contain. Chlorine 
gas is not readily handled but the lime enables us to put it where we 
will. It cannot be employed to disinfect colored fabrics as it bleaches 
them. 

Whenever chlorinated lime is bought the physician should see that 
all its chlorine has not departed from it as most of the material kept 
in the stores is so old as to be worthless. 

For scrubbing floors chlorinated lime may be made into a solution 
by adding a cupful to a bucket of water, and in privies it may be 
spread thickly over the surface of the mass of filth. 

It is useless to place chlorinated lime around the room for the 
purpose of disinfecting the air as the amount of chlorine to the 
volume of air to be disinfected is as nothing. 

Copperas, or sulphate of iron, while largely used as a disinfectant 
is only an antiseptic. 



HEAT. 

Heat is used locally for a number of purposes in the same manner 
as is cold, and, as was stated in the article on cold, the choice of heat 
or cold, in the treatment of any acute form of inflammation, depends 
almost entirely upon the desire of the patient, who generally can tell 
at once which will give him the greatest comfort. 



HEAT. 321 

In sprains of the ankle nothing compares to a hot foot-bath pro- 
longed for hours, the object being to decrease the pain and swelling, 
thereby obtaining the rapid use of the limb. To carry this out 
effectively a piece of rubber tubing of small size should be led from 
a wooden bucket, which being a bad conductor of heat prevents the 
water from being chilled, to a sink or large tub near by, and by start- 
ing the water by suction a continuous bat very small stream can be 
made continually to leave the bucket, while by means of another 
similar arrangement running either from another tub or, better still, 
from a hot-water spigot, a small stream of hot water continually 
enters to take the place of that withdrawn by the first siphon. 
Under these circumstances a very constant temperature of the water 
can readily be obtained, the high degree of heat borne, by gradually 
increasing the temperature of the water in the supply tube, is very 
extraordinary, the favorable results obtained being in direct ratio to 
the excess of temperature. Between these soakings the part should 
be dressed with lead water and laudauum, and rubbed now and then 
with camphor liniment containing laudanum. 

In spasmodic affections involving either striped or unstriped mus- 
cular fibre the local application of heat is a very useful means of 
relief. Sometimes in lumbago or muscular stiffness in other parts of 
the body the use of an ordinary laundry iron over the affected part 
will prove of great service, the skin being covered by several layers 
of newspaper to afford a smooth surface over which to pass the iron 
and to protect the parts from too great heat. 

In chordee the best means for rapid relief, other than the use of 
drugs or general relaxants, such as amyl nitrite, is to steep the penis 
in hot water and to take a hot sitz bath before going to bed, which is 
a good prophylactic against this painful complication of gonorrhoea 

In croup of the spasmodic type the local application of a hot com- 
press, made by wetting spongiopiline with hot water, is very useful, 
or if spongiopiline cannot be had several layers of flannel should be 
.so wetted, placed on the neck, and covered with cotton and oil silk to 
prevent its becoming chilled. 

Where attacks of dysmenorrhea depend upon spasmodic closure 
of the cervix, with corresponding spasm of the fundus uteri, a hot 
sitz bath or vaginal injection is useful, and this treatment is also of 
value where uterine congestion results in leucorrhcea or a sensation 
of weight in the pelvis. Sometimes attacks of torticollis may be 
subdued by applying hot compresses to the sterno-mastoid muscle. 

In universal or partial spasm of the body, as is well represented 
by chorea, a hot pack is of great service, and it is to be used in the 
following manner : The child having first been stripped of all clothing 
is placed upon a bed covered by a rubber blanket and immediately 
wrapped in a woollen blanket which has been dipped in hot water 
and the excess of water wrung out of it. Over this wet blanket is 
immediately wrapped a dry one to retain the heat, and very soon the 

21 



322 REMEDIAL MEASURES. 

patient begins to perspire freely. Care should of course be taken 
that the temperature of the patient does not rise too high before 
sweating comes on. This hot pack will sometimes quiet a case of 
chorea which has resisted all forms of treatment so far as drugs are 
concerned. Cases of insomnia are often benefited by a similar expe- 
rience, or mild cases of sleeplessness will occasionally rest quietly 
after an ordinary hot bath. 

A wet pack which speedily becomes a warm one is used in cases 
where, during the course of an eruptive fever, the eruption fades 
and it is desired to bring it out again on the surface. It is also 
useful in the cases of severe chorea when the child can stand the 
first shock of the cold. It consists in wrapping the child in a cold 
wet sheet and over this wrapping one or two blankets. In a few 
minutes the sheet becomes heated from the body and the sweating 
which results is profuse. Cold may be applied to the head to relieve 
cerebral hyperemia and to prevent overheating. 

The use of heat in two forms has been and is largely used at 
present for medicinal purposes when the kidneys or skin is torpid to 
aid in. the elimination of impure and effete materials from the blood 
and tissues. These two forms of heat, the dry and the moist, are 
commonly called the Turkish and Kussiau bath respectively, and 
may be taken under home arrangements or in one of the establish- 
ments found in all lar^e cities. 

The first of these is in the form of dry heat, the second is moist 
heat. The Turkish bath consists of a series of rooms ranging in 
temperature from 100° F. to 150° F. or more, into which the indi- 
vidual passes successively until the hottest room is reached. In each 
chamber he lingers until the system becomes accustomed to the high 
temperature, and perspiration is well established before he enters the 
hottest room, where he remains for a varying length of time, accord- 
ing to the advice of his physician or his own whim or comfort. The 
rule governing his stay is that he must leave it at once if any sense 
of oppression is experienced or if perspiration does not freely flow. 
Sometimes a glass of cold water taken at this time causes a sudden 
profuse sweat and also relieves any overheating by abstracting many 
units of heat. The cold water in the centre of the body causes con- 
traction of the bloodvessels in these parts and the blood rushing to 
the surface causes the sweat glands to pour out their secretion. 

Following the stay in the warm room the individual passes into 
still another chamber where he is shampooed from head to foot, well 
rubbed, and the blood made to circulate through the skin. The 
shower bath is then used, at first hot or warm and finally changed 
to a dash of cold, or better still the patient plunges into a long tank, 
swims to the other end and is there met by an attendant who rap- 
idly dries his skin, wraps a cover round him, and shows him to a 
lounge, where he is supposed to recline and sleep for an hour or less. 



HEAT. 323 

The air of this sleeping room is at the ordinary temperature of a 
living room. 

Reviewing for a moment the effects of this bath we find that the 
first two-thirds are devoted to the openiug and stimulation of the 
pores of the skin, while the last third is devoted to the contraction 
of these pores and their supplying bloodvessels. In other words, it 
is necessary to use the cold to prevent gradual chilling of limited 
areas, which would result in internal congestion. If the patient re- 
ceives a cold douche the natural rebound prevents congestion of a 
permanent nature, whereas if he is exposed to cold a long time these 
stagnated areas become permanently diseased. The physician must 
always remember that this cold douche or plunge is a sine qua non, 
and that a rest after the bath before dressing is almost equally im- 
portant. If the patient is too weak to bear the cold he must not use 
the bath. 

The indication for the Turkish bath, as a medicinal measure, is 
any condition of the emunctories of the body whereby effete matters 
are not properly eliminated, as in Bright's disease in its various 
forms. The increased action of the skin not only for the time being 
casts off impurities, but the frequent repetition of the bath causes func- 
tional hypertrophy of the sweat-glands, and eventually enables them 
to do more work or, in other words, to cast off more effete materials. 
As a consequence of this the patient is able to avoid uraemia or other 
evidences of Bright's disease, and using the normal epithelium still 
left in the kidney for constant use employs the bath once, twice, or 
thrice a week with the object of abstracting the excess of impurities 
which the impaired activity of his kidneys cannot remove. The 
frequency of the bath depends, therefore, upon the rapidity with 
which the effete materials accumulate. Iu cases of Bright's disease 
the patient should not attempt to use the room containing high heat 
at first, and should be accompanied by a medical attendant to watch 
for untoward effects, particularly if the heart is diseased or uraemia 
is already shown by headache or other signs. If sweating does not 
come on at once danger is at hand from acute uraemia, renal and 
cerebral congestion, or heat-stroke. 

Not only is the Turkish bath useful for kidney disease, but it is 
often of great service in rheumatism. The acute form of rheuma- 
tism is rarely so treated, because cardiac complications often prevent 
exposure to heat. In subacute and chronic rheumatism the case is 
different, and the enlarged joints or inflamed muscles yield like magic 
in some cases to such treatment. Further than this, the muscular 
stiffness following prolonged or severe effort can be so put aside, and 
neuralgia depending upon rheumatic or gouty taint may be relieved 
by the hot-air bath. Acute colds in the head or elsewhere, if taken 
at an early formative stage, can often be aborted by a good Turkish 
bath and greatly relieved when further developed by the same means. 
If, however, congestion of the lung, pneumonia, or chronic bron- 



324 REMEDIAL MEASURES. 

chitis, with emphysema or dilated weak heart, exist, the bath may be 
dangerous. 

In acute pharyngitis, in which the pharynx feels like a raw sur- 
face, or "as if it were filed or scraped/' the bath. will give relief in 
mauy instances. 

Sometimes in suppression of menstruation from cold the flow may 
be restored by a Turkish bath. 

Some persons exist who complain that they are always catching 
cold upon the slightest provocation, and sometimes apparently with- 
out cause. One class seem to have delicate mucous membranes readily 
susceptible to irritation and inflammation, the other have dilated or 
relaxed peripheral capillaries, which readily allow the blood in them 
to become chilled, and, consequently, cause internal local congestions. 
Two separate means of treating such cases exist. The first set will 
do well on minute doses of arsenious acid (grain T ^ to -tfo) three 
times a day, used for weeks ; the second will be cured of their habit 
by the use of a Turkish bath twice or thrice a week, since by this 
means the peripheral capillaries are toned up and made more active. 

The Turkish bath, as thoroughly carried out in large cities, is not 
obtainable for those living elsewhere, so it is well to describe a home 
modification which, with attention to detail and care, may prove 
almost, if not quite, as effective a remedy. 

The patient is placed upon a wicker chair, naked, and under the 
chair a small alcohol lamp is put, which is lighted. The individual 
is now wrapped thoroughly,, chair and all, with one or two large 
blankets, and the heat of the lamp soon causes profuse sweating. 
Many cases are, however, on record where the lamp was upset and the 
patient badly burned. Indeed, the eminent physiologist, Dr. Car- 
penter, so met his death. The best way is to have a lamp a little to 
one side and its flame immediately under the mouth of an inverted 
funnel attached to a piece of tin tubing, the free end of which is 
placed under the blanket so that the hot air and vapor may surround 
the body. If the tube be covered with cloth the loss of heat is slight 
and the danger of burning the patient is removed. If this is not 
practicable several very hot bricks or stones, thoroughly heated in 
an oven, may be placed under the chair, or small heated logs may be 
substituted 

The Russian bath differs solely from the Turkish in that the heat 
used is moist not dry. As a consequence the clanger of heat-stroke 
and similar states is much increased, because evaporation from the 
skin does not go on so rapidly and the body is not cooled so well in 
consequence. In its place the patient may be given a warm pack 
which consists in wrapping him in a sheet and surrounding him with 
large blankets wrung out of water as hot as can be borne, which is 
in turn covered with a dry blanket to prevent cooling. 

This method of treatment is useful in the same states as is the 
Turkish bath, but is more rarely used. The warm pack just named is 



HEAT. 325 

also employed to develop the rash of any of the exanthematous fevers 
when it is suppressed by cold or is not '" well out" on the skin. The 
temperature of the patient must be watched lest he fails to have 
sweating and develops heat-stroke in consequence. A thermometer 
should be kept constantly under the tongue during the use of the 
pack. 

Whenever the Russian bath is used, except in the exanthematous 
fevers, it should be followed by a cold douche. 

Although these baths have been used in heart disease to relieve 
dropsy and renal engorgement they are not safe and should not be 
generally employed. All acute or chronic diseases of the lung, except 
acute bronchitis of a mild form, contra-indicate their use. 

Kalashnikoff has made a series of observations on the therapeutic 
effects of heat on syphilis, and especially on syphilitic eruptions, his 
patients beiug inmates of the St. Petersburg Lock Hospital for 
Women and Children. The heat was applied where possible by 
means of partial hot-air baths applied to the affected part for half an 
hour twice a day, the part being enveloped in hot flannel immediately 
afterward, and remaining so protected until the next hot-air bath. 
The temperature never exceeded 116° F. (46.6° C). Where the 
eruption was on the back or neck or on some part which it was 
impossible to insert in a hot-air chamber, India-rubber hoti-water 
bottles or tubes, through which the hot w r ater was kept flowing, were 
employed. When both arms or legs were affected in a symmetrical 
manner the treatment was confined to one side, the other being left 
untreated for the purpose of comparison. The results showed that 
generally speaking the heat treatment acted very energetically and 
beneficially on syphilides, both when employed alone instead of 
mercurials and iodides, and also when used in conjunction with these 
remedies. Often heat proved beneficial when the ordinary specifics 
had failed. Among other observations it was noted that hard 
chancres healed and the induration disappeared in from 8 to 16 days; 
roseola and papular erythema disappeared in from 4 to 8 days ; 
various forms of papular and impetiginous syphilides, with marked 
pigmentation, disappeared in from 8 to 21 days ; non-ulcerated 
tubercles and gummata disappeared in from 7 to 24 days, but those 
which had already begun to ulcerate required from 1 to 6 weeks ; 
periostitis was cured in from 10 to 24 days ; ostoses were not 
affected ; syphilitic ulcers, consequent on the breaking down of 
gummatous periostitis, required treatment of from 6 weeks to 3 
months or more, while necrosis of bone frequently required many 
months' treatment before the sequestra could be got away. 



826 REMEDIAL MEASURES. 



KATAPHORESIS. 

By the term kataphoresis we mean a method resorted to by 
physicians having for its purpose the introduction into the body of 
drugs through the influence of electricity. Correctly speaking kata- 
phoresis is an osmosis of medicaments through the tissues, the osmosis 
being carried on by the electrical current and the drug being car- 
ried through the tissues between the tw T o poles. Quinine, iodide of 
potassium, the various soluble salts of mercury, and chloroform and 
ether may be so used. The ordinary sponges or absorbent cotton 
tips of the electrodes may be saturated with the medicament to be 
u^ed, and the constant current employed, the current being reversed 
every few minutes. The positive pole of the battery is placed over 
the affected part, and the negative at a little distance away. 

In cases of neuralgia, chloroform and alcohol, each one-half, or 
even pure chloroform may be employed, and in syphilitic nodules, 
when the patient's stomach cannot stand drugs, kataphoresis over 
the part affected, with iodides, may be resorted to. The iodide of 
lithium is commonly employed in the strength of 5 per cent, in these 
cases. The strength of the current depends upon the size of the 
electrodes and the sensations of the patient. It is not necessary to 
use a stronger current than the patient can bear with comfort. 



VENESECTION. 

Bleeding or Phlebotomy is so rarely practised to-day that very 
many of the profession have never abstracted blood for therapeutic 
purposes, or even seen it done by some one else. Furthermore, it 
is to be feared that many of the younger physicians would hardly 
know how to bleed if called upon to do so at a crisis. All this is 
wrong, for bleeding is a measure undoubtedly of the greatest value 
and one which every one may be called upon to resort to. Like 
many medical measures it was sadly abused in the early part of this 
century, and people were bled with the same regularity that they 
were put to bed. 

The indications for venesection are as clear and well-defined as are 
the indications for any remedy. Briefly stated, we may say that all 
states of the circulatory apparatus denoting high arterial tension and 
excitement are indications, and that weakness, low arterial tension, 
and systemic or circulatory depression are contra-indicatious. Since 
the use of veretrum viride has become more common the conditions 
indicating venesection have been lost sight of because this drug so 
dilates the blood paths that a man is bled into his own vessels. 

Having made clear the general indications for the use of venesec- 



VENESECTION. 327 

tion, we may pass on to state some of the diseases in which it may be 
well resorted to. Of these, pneumonia, pleurisy, meningitis, and 
peritonitis, if they are sthenic, are typical examples, since all of them 
are accompanied by arterial excitement and characterized by local 
congestions affecting the lung, pleura, cerebral membranes, or peri- 
toneum. (See Pneumonia.) By the abstraction of blood the vas- 
cular tension is lowered and the engorged area relieved. In the 
first place, the congested area is made up of relaxed bloodvessels, 
whereas the remaining bloodvessels of the body are tense and, as a 
consequence, the blood is urged to the spot already engorged. In 
the second place, the abstraction of blood from the tense bloodvessels 
leaves the general pressure lower than that in the diseased area and 
the congestion is relieved. 

In apoplexy the extravasation of blood into the brain causes great 
arterial excitement, as a general rule, and this in turn results in 
increased intracranial haemorrhage. Bleeding is, therefore, strongly 
indicated, not only to prevent inflammation, but also to prevent 
further leakage into the brain substance. 

The method by which venesection is practised is yet to be described, 
and it is a very simple operation if an assistant is present to make 
pressure on the vein or entire arm. Often this pressure is best exer- 
cised by means of a handkerchief or bandage tightly twisted about 
the arm above the spot where the incision is to be made. Under 
these circumstances the veins of the arm become prominent and dis- 
tended and one of them may be gently bared by a short longitudinal 
incision of half an inch, the fascia being separated until the glistening, 
blue surface of the vessel appears free from fat or connective tissue. 
Into this vessel, with the edge of the knife turned upward, a small 
longitudinal incision is made, care being taken that the point of the 
blade is not driven in far enough to injure the posterior wall of the 
vein. If a clot forms and stops the flow it must be removed by an 
aseptic cloth, while if the flow is to be stopped we may remove the 
bandage above and apply a compress over the incised vein, which 
compress may be held in position by a bandage. 



FOODS FOR THE SICK 



PEPTONIZED MILK. 

Take a perfectly clean, clear glass quart-bottle and place in it the 
contents of one of Fairchild Bros., or Parke, Davis & Co.\s pepton- 
izing tubes and a teacupful of cold water, and after shaking pour into 
the bottle a pint of perfectly fresh, cool milk and stir the mixture thor- 
oughly. Next place the bottle containing the milk in a can of water 
at such a temperature that the whole hand of the nurse may be sub 
merged in it indefinitely without paiu. If complete digestion of the 
milk is desired, this application of heat may be continued as long as 
twenty minutes but in most respects five minutes is sufficient. If 
carried on longer than twenty minutes, the milk will become bitter 
and disagreeable to the taste through the development of peptone in 
excess. 

Immediately after taking the bottle from the hot water it should 
be placed on ice, in order to check further peptoniziug and to keep 
the milk from spoiling ; or if ice is not available the water bath should 
be quickly brought to a boil, in order to prevent further action of 
the ferment and the bottle be then placed in a cool place. This 
recipe may be used where it is thought necessary to digest the milk 
before it is swallowed. Where w T e desire simply to aid digestion it 
is best to follow the directions already given, except that the bottle 
is not heated but at once placed upon ice and allowed to remain 
there, being slightly warmed when it is desired to give it to a child, 
or it may be given as a cool and refreshing drink to an adult, the 
heat of the body rapidly causing the ferment to do its work as soon as 
the food enters the stomach. Where irritability of the stomach exists 
in adults this peptonized milk may be made more agreeable to the 
taste by following the directions given in the first recipe, except that 
it must remain in the hot water for no less than two hours, when it 
is poured out into a tincup or pan and rapidly brought to the boiling 
point. After this it is strained through a piece of coarse muslin 
and placed upon ice. Before giving it to a patient this mixture may 
be flavored with lemon or orange juice or any form of acid that is 
desired, without the milk becoming curdled. Peptonized milk punch 
is made from milk prepared in the way already described in the first 
recipe, by adding St. Croix or Jamaica rum or brandy, particularly 
if the surface be sprinkled with a little grated nutmeg. 



PEPTONIZED GRUEL. 3*29 

A very refreshing and agreeable drink may be made by diluting 
peptonized milk one-half with highly charged carbonic acid water 
and drinking it while effervescing. 



Peptonized Beef. 

The following method of preparing peptonized beef is recommended 
by the Fairchilds and is very useful, as is also peptonized oyster stew 
as first introduced by my late friend, Dr. 1ST. A. Randolph, of the 
University of Pennsylvania : 

Take J pound finely minced, raw lean beef; cold water, J pint. 
Mix in a saucepan. Cook over a gentle fire, stirring constantly until 
it has boiled a few minutes. Then pour off the liquor for future use, 
and beat or rub the meat to a paste, and put it into a clean fruit jar 
with J pint of cold water and the liquor poured from the meat. 

Add — Extractum Pancreatis (Fairchild) . . . .20 grains. 
Sodii Bicarb. . . ..... 15 grains. 

Shake all well together, and set aside in a warm place, at- about 
110° to 115°, for three hours, stirring or shaking occasionally; then 
boil quickly. It may then be strained, or clarified with white of 
egg in the usual manner, and seasoned to taste with salt and pepper. 

For the great majority of cases it will not be required to strain the 
peptonized liquor, for the portion of meat remaining undissolved will 
have been so softened and acted upon by the pancreatic extract that 
it will be in very fine particles and diffused in an almost impalpable 
condition, and is, therefore, in a form readily subject to assimilation 
in the body. 

Peptonized Oysters. — Peptonized oysters are prepared by mincing 
6 to 12 large oysters and adding to them, when mixed with a 
moderate amount of their own liquid, 5 grains of pancreatin or 
peptonizing poAvder and 20 grains of sodium bicarbonate. The cup 
containing this mixture is now placed in warm water at 100° F. 
and allowed to remain there from ten to twenty minutes according 
to the degree of digestion desired. After this the liquid mass is 
quickly brought to a boil to cook the oysters and stop digestion, 
and served with pepper and salt as required. Any condiment or 
flavoring may be used. 



Peptonized Gruel. 

Peptonized gruel may be made by taking thoroughly boiled hot 
gruel made from oatmeal, barley, wheat, or from arrow-root, to the 
amount of \ pint, and adding thereto while it is hot, J pint of fresh, 



330 FOODS FOR THE SICK. 

cold milk ; to this may now be added the contents of one peptonizing 
tube and the mixture allowed to stand in moderately hot water or 
in a warm place for 20 minutes before it is placed upon ice. 



KOUMYSS. 

This is a preparation of milk largely used by children and adults 
during convalescence from acute or subacute exhausting diseases. 
Even young children of three or four years will take a fancy to it if it 
be not made too sour by continuing the fermentation process too long. 
The liquid is prepared as follows : Add to 1 pint of cool, perfectly 
fresh milk 2 teaspoonfuls of sugar and place, after shaking thor- 
oughly, in a beer or claret bottle. Then add ^ of a cake of Fleisch- 
man's compressed Vienna yeast and tightly cork the bottle, standing 
it in a warm place or in a water-bath at 99° to 100° F. for eight to 
ten hours. Then place in a cool place or on ice and use as needed. 
It must be remembered that the development of carbonic gas is very 
great in this liquid, and that if an ordinary cork is inserted it must be 
tied in before the heat is applied. Further than this the cork must 
be pulled very gently or the liquid will squirt all over the room. 
The best thing to use when about to drink the koumyss is a " cham- 
pagne tap," by means of which the liquid may drawn off as needed. 



DIET LIST. 

The following bills of fare are used in the Children's Hospital and 
in the children's department of the University Hospital in this city, 
with good results, and are easily prepared and the directions readily 
carried out by the inexperienced : 

Diet in Gastro -intestinal Catarrh for a Child of Seven Years. 

Breakfast, 7.30 a.m. : Milk, with lime water; 4 tablespoonfuls of 
lime water to each tumblerful of milk. The lightly boiled yolk of 
an egg, a thin slice of well-toasted bread, or stale bread. 

Dinner, 12 m. : A mutton chop without fat, broiled, or a slice of 
roast beef or mutton, occasionally a bowl of meat broth. Stale 
bread or toast. 

Supper, 7 p.m. : Milk and lime water. Stale bread or toast. 

For drink : Filtered or boiled water. 

Starch -foods to be avoided as much as possible. 



DIET LIST. 331 

Diet for a Child Two Years Old. 

Breakfast, 7 30 a.m. : Milk. The lightly boiled yolk of an egg. 
Thin bread and butter (bread one day old) 

Lunch, 11 a.m. : Milk. A thin slice of bread and batter. 

Dinner, 1.30 p.m. : Beef-tea or small piece of minced roast beef or 
mutton devoid of gristle. One well mashed potato, moistened with 
gravy. Rice and milk. 

Supper, 6 p.m. : Milk. Bread and butter. 

For drink : Boiled or filtered water. 

Diet for a Child One Year Old. (5 meals a day.) 

First meal, 7 a.m. : Two teaspoonfuls of grated flour-ball in half 
a pint of milk (prepared as directed below). 

Second meal, 10.30 a.m. : Haifa pint of milk with 4 tablespoon- 
fuls of lime water. 

Third meal, 2 p.m. : The yolk of 1 egg beaten up in 1 teacupful 
of milk. 

Fourth meal, 5 30 p.m. : Same as the first. 

Fifth meal, 11 p.m. : Same as the second. 

Flour-ball is to be made by taking 1 pound of good flour — un- 
bolted, if possible — tie it up very tightly in a pudding bag ; put it in 
a pot of boiling water early in the morning, and let it boil till bed- 
time, then take it out and let it dry. In the morning peel off from 
the surface, and throw away, the thin rind of dough, and with a 
grater grate down the hard, dry mass into a powder. To use this, 
take from 1 to 2 teaspoonfuls of the powder, rub it down till 
smooth with a tablespoonful of cold milk, and add 1 tumblerful of 
hot milk, stirring it well all the time. 

Diet for a Child from Six to Twelve Months Old. (5 meals a day.) 

First meal, 7 a.m. : Mellin's food, 1 tablespoonful, or flour-ball 
grated, 1 or 2 teaspoonfuls (prepared as directed above), hot w T ater, 
4 tablespoonfuls ; warm milk enough to make half a pint. Dissolve 
the Mellin's food or rub down the grated flour-ball in the hot water 
by stirring, then add the milk ; mix thoroughly. 

Second meal, 10.30 a.m., and third meal, 2 p.m. : A breakfast- 
cupful of milk with 4 tablespoonfuls of lime water. 

Fourth meal, 5.30 p.m. : Same as first. 

Fifth meal, 10.30 p.m. : Same as second. 



332 FOODS FOR THE SICK. 

Beef Tea. 

Take 1 pound of lean beef, and mince it. Put it, with its juice, 
into an earthen vessel containing a pint of tepid water, and let the 
whole stand for one hour; strain well, squeezing all the juice from 
the meat. Place on the fire, and slowly raise just to the boiling 'point, 
stirring it briskly all the time. Season with salt and pepper to taste. 
In administering this, always be careful to stir up the sediment. 

Or, take two pounds of beef, without fat or bone, half a breakfast- 
cupful of cold water ; place it in a jar in a sauce-pan of water. 
Simmer four hours. 



Barley Water. 

To prepare barley water, put 2 good teaspoonfuls of washed pearl 
barley Avith 1 pint of cold water in a saucepan, and boil slowly down 
to two-thirds. Strain. 



Wine Whey. 

Boil 1 pint of fresh milk ; while boiling, pour in 1 small tumbler- 
ful of sherry wine (8 tablespoonfuls), bring it to the boil a second 
time, being careful not to stir it ; as soon as it boils set it aside until 
the curd settles, and pour off the clear whey. 



Almond Bread for Diabetics. 

Take of blanched sweet almonds J pound, beat them as fine as 
possible in a stone mortar ; remove the sugar contained in this meal 
by putting it into a linen bag and steeping it for a quarter of an 
hour in boiling water acidulated with vinegar; mix this paste thor- 
oughly with 3 ounces of butter and 2 eggs. Next add the yolks of 
3 eggs and a little salt, and stir well for some time. Whip up the 
whites of three eggs and stir in. Put the dough thus obtained into 
greased moulds, and dry by a slow fire. 



Bran Bread for Diabetics. 

Take a sufficient quantity (say 1 quart) of wheat-bran ; boil it in 
two successive waters for a quarter of an hour, each time straining it 
through a sieve ; then wash it well with cold water (on the sieve) 
uutil the water runs off perfectly clear; squeeze the bran in a cloth as 
dry as you can, then spread it thinly on a dish and place it in a 
slow oven ; if put in at night, let it remain until morning, when, if 



RESTORATIVE BEEF ESSENCE. 333 

perfectly dry and crisp, it will be fit for grinding. The bran thus 
prepared must be ground in a fine mill and sifted through a wire sieve 
of such fineness as to require the use of a brush to pass it through ; 
that which remains in the sieve must be ground again until it be- 
comes quite soft and fine. Take of this bran powder 3 ounces 
(some patients use 4 ounces). The other ingredients as follows : 3 
new-laid eggs, 1J ounces (or 2 ounces, if desired) of butter, and about 
J pint of milk; mix the eggs with a little of the milk, and warm 
the butter with the other portion ; then stir the whole well together, 
adding a little nutmeg and ginger, or any other agreeable spice. 
Bake in small tins (patty-pans), which must be well buttered, in a 
rather quick oven for about half an hour. The cakes, when baked, 
should be a little thicker than a ship's biscuit ; they may be eaten 
with meat or cheese, at breakfast, dinner, or supper ; at tea they 
require rather a free allowance of butter or may be eaten with curd 
or any of the soft cheeses. 

" It is important that the above directions as to washing and dry- 
ing the bran should be exactly followed, in order that it may be freed 
from starch and rendered more friable. The bran in its common 
state is soft, and not easily reducible to fine powder. In some sea- 
sons of the year, or if the cake has not been well prepared, it changes 
more rapidly than is convenient. This may be prevented by placing 
the cake before the fire for five or ten minutes every day." 



Restorative Beef Essence. {Ringer.) 

Take 1 pound of fresh beef, free from fat, chop it up fine, and 
pour over it 8 ounces of soft water, add 5 or 6 drops of hydro- 
chloric acid, and 50 or 60 grains of common salt, stir it well, and 
leave it for three hours in a cool place.. Then pass the fluid through 
a hair sieve, pressing the meat slightly, and adding gradually toward 
the end of the straining about 2 ounces more of w r ater. The liquid 
thus obtained is of a red color, possessing the taste of soup. It 
should be taken cold, a teacupful at a time. If preferred warm, it 
must not be put on the fire, but heated in a covered vessel placed in 
hot water. 

Should it be undesirable for the patient to take the acid, this soup 
may be made by merely soaking the minced beef in distilled water; 
or take 1 pound of gravy beef, free from fat and skin, chop it up 
very fine, add a little salt, and put it into an earthen jar with a lid, 
fasten up the edges with a thick paste, such as is used for roasting 
venison in, and place the jar in the oven for three or four hours. 
Strain through a coarse sieve, and give the patient two or three 
teaspoontuls at a time ; or cut up in small pieces 1 pound of lean 
beef from the sirloin or rump, and place it in a covered sauce-pan, 
with J pint of cold water, by the side of the fire for four or five 



334 FOOD FOR THE SICK. 

hours, then allow it to simmer gently for, two hours, skim it well, 
and serve. 

Mulled Wine. 

Boil some spices, cloves, nutmeg, cinnamon, or mace, in a little 
water, and add as much of this decoction as is necessary to flavor a 
wineglass of sherry, or any other wine. Add sugar to taste, and 
bring the mixture to a boiling point. If claret is used, it will require 
more sugar than if a less sour wiue is employed. The vessel for 
heatiug the wine should be scrupulously clean. 



PART IV. 

DISEASES. 



ABORTION. 

The treatment of abortion divides itself into three parts : the first 
to its prevention, the second to its arrest when threatened, the third 
to its proper care when inevitable. 

In the preventive means we find, as in nearly every branch of 
medicine, that the use of hygienic measures is more important than 
the employment of drugs. If the previous abortions be known 
to be due to syphilis, endometritis, or uterine displacements these 
conditions must be treated by their proper remedies. If there exists 
no apparent cause for the interruption of normal gestation, the 
patient should use a simple diet, lead a quiet life, avoid all sexual 
intercourse, sleep on a hard bed, and resort only to gentle exercise. 
Fresh air is, however, a necessity and should be plentifully obtained. 
The food should be light, but nutritious and palatable, and a suffi- 
cient variety supplied to avoid any repugnance to a given dish. In 
many cases abortion rests upon deficient nutrition of the foetus, either 
by reason of faulty assimilation on the part of the mother or because 
of poor food, and, if anaemia, debility, or other impoverished states 
of the maternal system be present, these should be treated at once. 
The clothing should be loose, the night's sleep undisturbed and of 
full length, and the mind be set as far as possible at rest in respect 
to household and other worries, and particularly diverted from the 
thought of possible uterine disturbance. 

The use of drugs is to be limited strictly to the fulfilment of a 
distinct indication, and the employment of cathartics is to be avoided, 
the bowels being kept in order by fresh fruits in moderate quantity, 
or by mild laxatives, such as cascara sagrada in small doses and 
compound licorice powder. If these fail rhubarb may be resorted 
to and castor oil in capsule may be used. Podophyllin, senna in full 
doses, saline purges in active amounts, and aloes, are not to be used 
if they can be avoided. If the woman be exceedingly stout and 
plethoric saline purges are indicated to act as depletants. It is hardly 
necessary to add that elaterium and scammony, or jalap, are not 



336 DISEASES. 

safe, and cau only be used if dropsy and ascites are present and where 
we must choose the least of two evils. Strychnine, which stimulates 
the spinal cord, should never be employed, and cantharides, oil of 
erigeron, and manganese ought not to be used unless they are for 
some reason very necessary. Although quinine is not of itself aborti- 
facient, it is unsafe if an abortive tendency is present, and can only 
be used when the abortion is brought on by malarial poisoning, when 
it will act as a preventative. 

The only drug which seems to be of any service as a prophylactic 
to be taken all through pregnancy is the fluid extract of viburnum 
prunifolium, the close of which is J to 1 drachm. This drug is said 
to be a uterine sedative and to have no injurious effects upon the 
mother or child. 

Cimicifuga racemosa is probably equally valuable as a prophylactic 
against abortion in the dose of 10 to 20 drops night and morning of 
a good sample of the fluid extract. 

The arrest of threatened abortion is one of the most difficult duties 
which come to the physician, and there is no doubt that large 
doses of morphine or opium are the best means of quieting the uterus 
that we have. While viburnum prunifolium may be resorted to, 
we do not know enough of it to rest assured of its value, but it 
should be tried if opium is not at hand or fails. The patient should 
be at once placed quietly in bed in the most comfortable position, be 
lightly covered to prevent over-heating and taking cold, and receive 
by the hypodermic needle J grain of morphine, or better still, 
an injection of warm starch water containing 30 drops of laudanum. 
The bulk of the injection should be small in order not to disturb the 
bowels, and must be at the bodily temperature. If this is not done 
a suppository of the aqueous extract of opium, containing J to J 
grain should be used. Ice-cold drinks should be given and no tea 
or coffee allowed. This treatment quiets the uterus, allays nervous- 
ness and restlessness, and at least puts off the abortion for a few 
hours. Venesection has been practised in very plethoric women 
with advantage. 

When an abortion is inevitable it is to be treated by measures 
directed to the avoidance of hemorrhages, the thorough delivery of 
the ovum and its appendages, and the prevention of inflammation 
and septicaemia. For the prevention of haemorrhage a number of 
balls of absorbent cotton tightly wound with thread to the size of a 
small egg should be packed into the vagina back of and around the 
cervix until the bleeding is controlled, and while a small amount of 
iodoform may be dusted over them before they are inserted, no astrin- 
gents is to be applied unless it be tannic acid to coagulate the blood 
in the cotton as astringents cannot reach the bleeding spot. Sponges 
ought never to be used as they often fail to control the bleeding. 
By means of this packing the blood in the uterus cannot escape, 
and, as the uterine walls contract, they urge the liquid between the 



ABSCESS. 337 

membranes, thereby causing complete separation. Ergot should be 
used after the tampons are applied in the dose of a fluidrachm of the 
extract or a tablespoonful of wine. Generally after twenty- four hours 
the removal of the tampons will show the ovum to be in the vagina, 
but if part of it remains in the uterus the following measures should be 
resorted to. The ergot should be withdrawn unless the haemorrhages 
are severe and the uterine cavity is to be cleared by the use of the 
fingers of the attendant who grasps the membranes and draws them 
away. If the cervical canal is too small it must be dilated by dila- 
tors or by packing it with sponge tents. After the membranes are 
removed the tincture of iodine should be applied to the inner surface 
of the uterus as a haemostatic, antiseptic, and alterative. 

The after-treatment consists in the use of small doses of ergot and 
quinine, of vaginal antiseptic irrigation or even of uterine irrigation 
if it is needed, and the maintenance of perfect rest for one or two 
weeks, or longer if possible. 



ABSCESS. 

The medical treatment of abscess resolves itself into the use of 
drugs to prevent the formation of pus, to cause its fatty degeneration 
and absorption, to quiet the systemic disturbance if the inflammation 
be severe, and to support the body if the suppuration be prolonged, or 
in large amount, or if debility exists. The treatment may also be 
divided into that suited to acute and chronic abscess. 

As acute abscess in its early stages is simply a localized inflamma- 
tion with hyperemia and an outpouring of leucocytes, it may often 
be aborted by the use of aconite or veratrum viride in full dose to 
quiet the circulatory excitement and relieve the congestion. This is 
particularly true where the pain is pulsating. At the same time, if 
the swelling is superficial, a poultice, made by moistening bread 
crumbs with lead water, should be placed over it, or lead water may 
be placed over it on lint and applied in this way. Belladonna oint- 
ment smeared over the same area may be of service, and the tincture 
may be used internally if aconite cannot be had. If a gland be in- 
volved the needle of a hypodermic syringe may be inserted obliquely 
into its centre and 5 to 10 minims of a 2 per cent, solution of carbolic 
acid injected into the swelling. This method has been found of 
singular efficacy in bubo where pus seemed just about to form. It 
is almost always curative, but should not be used in a stronger or 
weaker solution than that named. Another useful abortive method 
for the early stages of abscess is the application, externally, of a strong 
solution of nitrate of silver, 20 to 40 grains to 1 ounce of water, by 
means of a camel's-hair brush, all over the skin, covering the area 
involved, or by the use of the tincture of iodine in a similar manner. 

22 



338 DISEASES. 

Internally, sulphide of calcium in the dose of ^ grain every 
hour or two, may be used as au abortive, or at least to promote arrest 
and cause absorption. If it becomes evident that pus is going to 
form, then resort must be had to poultices which by their heat and 
moisture will aid in the formation of pus by favoring the escape 
of leucocytes and by softening the tissues. If pus forms and 
fluctuation ensues the abscess should be freely opened, drained, 
washed out by a solution of carbolic acid, in the strength of ] to 20, 
or of bichloride solution 1 to 5000 and dressed with antiseptic gauze. 
If it is tubercular the abscess may be opened in the ordinary manner, 
all diseased tissues removed by scraping and packed with iodoform 
gauze, or it should be drained by aspiration and an ethereal solution 
of iodoform injected and allowed to remain in the abscess cavity if a 
small one. The opening is now closed by a pledget of cotton wet 
with tincture of benzoin and an antiseptic dressing applied over it. 
Not more than 20 grains of iodoform should be so used in tubercular 
abscess. 

A very good treatment for slow abscess is to wash out the cavity 
with a 10 per cent, solution of peroxide of hydrogen. 

If the abscess is chronic (cold abscess) and associated with great 
weakness, resort must be had to the internal use of iron in the form 
of the tincture of the chloride, cod-liver oil, with hypophosphites, 
quinine as a tonic and to prevent hectic fever and the use of nutri- 
tious, easily digested food. Alcohol may be used and should be 
given with the milk. 

The following tonic pill and solution are of service : 



R. — Strychninse sulph. . . 


. gr.iv. 


Ferri redact. ....... 


. gr.xv. 


Quininse sulph. ...... 


. gr.xv, 


M. — Ft. in pil. No. xx. S. One t. d. after meals, or 




R. — Tr. cinchonse comp. "1 




Tr. gentian, comp. >- .... 


aa f^iij 


Tr. cardamom, comp. J 




M. — S. Dessertspoonful t. d. after meals. 





Having described the means of treatment it is to be explained 
how these measures act. The aconite quiets the circulation and 
thereby relieves the inflammation, the lead water acts locally as an 
astringent and sedative, while the belladonna by its action on the 
bloodvessels contracts the dilated capillaries and allays pain. When 
carbolic acid is injected into an enlarged gland it acts as an anaes- 
thetic and as an antiseptic to the germs always present, such as sta- 
phylococci, and as an astringent and stimulant. The nitrate of 
silver applications act by constringing the bloodvessels, as local sed- 
atives and as counter-irritants. The iodine applications do likewise 
and also exercise an alterative influence. 

The physiological action of the sulphide of calcium is unknown. 
The object in using the antiseptic irrigations is self-evident and the 



ACNE. 339 

employment of iodoform in tubercular abscess rests upon the studies 
of Brims, of Tubingen, and many others, who have found by experi- 
ment that iodoform is fatal to the bacillus tuberculosis. 

As large numbers of corpuscles are destroyed in the formation of 
pus, and other sources of vitality are sapped by its formation, the 
use of hypophosphites and iron to replace the loss is necessary, and 
of cod-liver oil and tonics to increase the blood corpuscles and the 
assimilation of food. 



ACNE. 

This aiFection occurs in so many forms and arises from such differ- 
ent causes that a thorough consideration of its treatment cannot be 
here given ; suffice it to state that arsenic is a remedy which will 
often cause a cure and prevent a relapse if used in small doses for a 
long period, that is : 1 to 3 drops of Fowler's Solution three times a 
day for a month or two. This is particularly useful if debility and 
anaemia underlie the disease. If the anaemia be marked, the proper 
treatment is that directed to the cure of this condition (see Anaemia); 
if obstinate constipation is present relief must be obtained by saline 
purges and the bowels kept in order by cascara sagrada or some sim- 
ilar drug. If scrofulosis exists cod-liver oil is of great service, or, 
if much pustulation is present, sulphide of calcium in the dose of 
-^ to ^ of a grain may be used in pill form three times a day. In 
menstrual acne sulphur may be used internally to open the bowels, 
and applied as a wash to the face in the following form : 

R.— Sulphur 3j. 

Glycerini . . . . . . . . f|jj. 

Aq. rosae qs. fgviij 

M. — S. Apply twice or thrice a day. 

Or the following may be used iu severe inflamed acne : 

R. — Sulphur iodidi ....... gr. xxx. 

Ceratum simplicis ...... ^j. 

Apply to the parts night and morning. 

If the skin is very atonic, muddy, and torpid, it should be bathed 
night and morning with hot water and castile soap, or even with the 
tincture of green soap, and rubbed well with a rough towel. 

If the green soap causes irritation some bland application should 
follow it, such as simple cerate or the emulsion of the oil of bitter 
almonds. If the pustules be large they may be incised and vent 
given to their contents, the sac being touched with a drop of carbolic 
acid. If induration is great, ichthyol ointment of the strength of 
20 parts of ichthyol to 100 of lard should be well rubbed in, or 
resorcin, 10 to 20 grains to the ouuce of lard, be applied. Mercu- 



340 DISEASES. 

rial ointment may also be used to relieve induration, but several 
days must elapse between its use and that of sulphur, as a black sul- 
phuret of mercury may be formed and stain the face. 



ADENITIS. 

Adenitis is an inflammation of the lymphatic glands generally 
arising from scrofulosis, unless there be some specific trouble such as 
syphilis present. Less commonly it occurs in the neck from the 
irritation produced by the eruption of milk teeth, sometimes from 
blows or exposure to cold. 

If the condition consists in a simple enlargement it should be 
treated by inunctions of iodine ointment and lard, half and half, 
night and morning, care being taken that the ointment is stopped 
as soon as any reddening of the skin appears, or if fluctuation de- 
velops. If the ointment cannot be used the tincture of iodine 
should be thoroughly painted over the swelling with a brush, but is 
less efficacious. Syrup of the iodide of iron in the dose of 5 to 10 
drops is to be given if the patient is a child, and tonics must be 
used to improve the systemic condition. As soon as fluctuation or 
reddening shows the formation of pus all this treatment should be 
stopped and a poultice be applied and kept on for twenty-four or 
forty-eight hours till the swelling goes down or is ready for lancing. 
Lancing is better than allowing the abscess to break, as the scar left 
in after years is a mere line instead of a large cicatrix. 

If the enlargement be scrofulous the following treatment, recom- 
mended by Treves aud Griinfeld, is of value, and should be per- 
formed if the patient will submit to it. 

The entire removal of the glands should be effected by dissection 
alone ; directors, handles of scapels, or fingers should be used to 
separate the glands from the surrounding cellular tissue as closely from 
the capsule as a nerve is cleaned in the dissecting room. When 
sufficient of the anterior surface is exposed, a thick thread is passed 
through the gland, drawn gently, when by continuing the dissection 
the operator may get gradually to the back of the gland, removing 
portions of the mass at a time. 



ALCOHOLISM. 

(See Alcohol, page 38.) 



AMBLYOPIA AND AMAUROSIS. 341 



AMBLYOPIA AND AMAUROSIS. 

Amblyopia, or dull vision, aud amaurosis, or blindness, usually 
refer to defective sight or its total loss, the result of functional dis- 
turbance of the retina, optic nerve, or visual centres, and unaccom- 
panied by changes in the eye-grounds in the beginning of the disease. 
These terms, however, include cases of partial or complete blindness, 
in which optic atrophy subsequently develops, and are often used to 
describe ocular disorders not limited by the definitions here employed. 

These cases may be gathered into certain groups : 

I. Congenital amblyopias and amblyopias from non-use of the 
eyes. 

In the former there is often a high degree of error of refraction, 
usually far-sightedness; the latter is seen when an eye is debarred 
from binocular vision by a squint. In both the treatment consists in 
as perfect a correction of the optical error as possible, and, in case 
one eye alone is involved, the separate exercise of its functions. Con- 
genital amblyopias n^ include incurable defects in the structure of 
an eye. 

II. Amblyopias, the result of (a) general diseases or conditions — 
typhoid fever, the exanthemata, syphilis, scurvy, malaria, colds, etc ; 
(6) local diseases or conditions — haemorrhoids, haemorrhage, preg- 
nancy, disordered menstruation, kidney disease, diabetes, migraine, 
disorders of the nervous system, etc. 

The remedies indicated by the special cause are to be employed ; 
the medicinal agents most usually needed being mercury, iodide of 
potassium, pilocarpine, particularly in ursemie amaurosis, emmena- 
gogues/ and tonics, especially hypodermics of strychnine. As local 
measures repeated fly-blisters to the temples, wet and dry cups, and 
the constant electric current are used. The nape of the neck may 
be cauterized or a seton introduced. In hysterical cases metallo- 
therapy may be tried. 

III. Amblyopias, the result of the action of certain medicinal 
and toxic agents. 

The abuse of alcohol, and particularly of tobacco, produces a form of 
amblyopia characterized by the development of a scotoma or an area 
in the centre of the field of vision, in which the appreciation of red 
and green is lost or greatly diminished. Quinine in excess has, in a 
number of instances, been followed by temporary blindness, which is 
usually denominated quinine amaurosis. Of less frequent occurrence 
are the cases of amblyopia produced by the toxic action of salicylic 
acid, lead, silver, mercury, osmic acid, nitro-benzol, and the vapor of 
sulphide of carbon. In all instances the patient must be withdrawn 
from the influence of the poison ; in tobacco amblyopia, in its early 
stages, this is usually sufficient to eifect a cure. The remedies which 
have proven of the greatest utility are digitalis, inhalations of nitrite 



342 DISEASES. 

of amyl, nitro-glycerin, and strychnine. Iodide of potassium should 
be exhibited in chronic cases, and always in amblyopias, the result of 
lead-poisoning. The constant current has also been employed. 

IV., Amblyopias the result of direct or indirect injury, or from 
reflex irritations. 

Traumatic amblyopias may follow a blow upon the eye itself, or an 
injury to the skull or spinal cord. To carious teeth, intestinal irri- 
tations, the presence of parasites and the like a certain number of 
amblyopias have been attributed, and while it is not possible to dis- 
prove the association, such cases must be received with doubt. After 
the removal of the cause, strychnine should be exhibited. 

Optic neuritis most frequently depends upon coarse diseases of the 
brain (tumor, abscess) or inflammation of its membranes (meningitis). 
It is also a symptom of numerous disorders — suppression of the men- 
ses, exposure to the cold, rheumatism (usually monolateral), anaemia, 
syphilis, uraemia, lead-poisoning, etc. The remedies are those nat- 
urally suggested by the disease or condition which has called it into 
existence. The prognosis depends upon the cause. Mercury, iodide 
and bromide of potassium, the salicylates, pilocarpine, local blood- 
letting, and fly blisters, are the remedies commonly employed. Optic 
atrophy is either primary, or secondary to disease of the brain or spinal 
cord, or consecutive to an antecedent neuritis. After all irritation has 
subsided the greatest improvement may be expected from hypodermic 
injections of strychnine which should be pushed to the point of toler- 
ance. Temporary improvement follows the inhalation of nitrite of 
amyl, and in the hope of improving the circulation in the optic nerve 
digitalis and similar cardiac tonics may be employed. 



AMENORRHEA. 

This condition depends upon so many causes for its existence that 
it must be treated in many different ways. If anaemia or chlorosis 
show that a deficient supply of blood is present, measures adapted to 
relieve such states are needed (see Anaemia), while if plethora is 
a cause depletants in the shape of saline purges are needed, but aloes 
are harmful. Correspondingly, in amenorrhea due to constipation 
salines and other purges may be used, but the best of these is aloes, 
and as constipation and anaemia often exist hand in hand a combina- 
tion of aloes and iron in a pill is commonly resorted to. The iron 
improves the blood, and the aloes stimulates and congests the pelvic 
viscera by bringing blood to the sexual organs. The following pill 
is often of service and is especially recommended by Goodell : 

R. — Extract, aloes aqueosi gj. 

Ferri sulphat. exsiccat £pj- 

Asafoetidse . . . . . . . . giv. 

M — Ft. in pil. No. 100 and give from 1 to 3 pills three times a day. 



ANEMIA. 343 

Cirnicifuga has been highly recommended in chronic and apparently 
causeless amenorrhoea, in the dose of 30 drops of the fluid extract at 
the time for a proper flow to occur. Within the last few years the 
binoxide of manganese in the dose of 1 to 3 grains has come for- 
ward as a prominent remedy in simple idiopathic amenorrhoea and 
is undoubtedly of service, but should be taken for at least two weeks 
before the date for each menstruation to occur. Potassium perman- 
ganate is also useful at the same time in similar states but it is inferior 
to the binoxide of manganese according to the author's experience. 

Apiol, the active principle of parsley, may be given in capsules in 
3 to 10 grains for the same condition, and oil of rue, savine, and 
tansy have also been employed in capsule in the dose of 5 drops t. d. 

In all forms of amenorrhoea a hot sitz-bath at the time for the ex- 
pected " period" is of service, more particularly if the patient has 
" caught cold." The bath should be persevered in for several nights 
and care should be taken to avoid exposure. Often a little mustard 
added to the water will increase the efficacy of this treatment. 

Under the name of the Dewees's emmenagogue mixture, first 
devised by Professor Dewees, of the University of Pennsylvania, 
the following formula has been largely used in functional and 
organic amenorrhoea : 



R. — Tinct. ferri. chlor. . 
Tinct. cantharidis . 
Tinct. guaiac. ammon. . 
Tinct. aloes 
Syrupi q. s. ad. 

M. — S. Tablespoonfal three times a day 



ANAEMIA. 



f^iss. 
f^ss. 



The theory of Buuge that sulphur in excess in the body prevents 
the assimilation of iron, and its indorsement by Clark is not gener- 
ally received as correct, for they claim that in chlorosis sulphides 
are formed in excess, and that this causes chlorosis by non-assimila- 
tion of iron, so that the question at once arises, How did the chlorosis 
come on in the first place, before the sulphides were formed? Sul- 
phides may aid in its continuance, but it is not proved that they 
produce it, and it is proved that they are often present in enormous 
quantities where no chlorosis occurs. Again, we have no proof that 
the manufacture of haemoglobin depends upon the absorption of iron 
alone. Clark thinks that when we give iron to such a case the sul- 
phides unite with it and the iron in the food escapes into the blood- 
making organs. Either the doses of iron must be very accurately 
fitted to the amount of sulphides, or excessive amounts must be 
used, so that no sulphide may be companionless. As all persons 
have sulphides present in sufficient amount to make a characteristic 



344 DISEASES. 

stool on taking iron, we should, according to this theory all have 
anaemia unless we protected the iron in our food by a constant use 
of the free metal. 

Practical experience does not support the use of enormous doses 
of iron in anaemia and chlorosis, but rather the contrary. The 
celebrated teachers "of the Dublin school years ago put forward the 
theory that small doses of iron were more useful than large ones in 
direct ratio to the severity of the disease, and the writer decidedly 
agrees with them. There is quite as much likelihood of failure of 
assimilation of iron by diseased organs as of its destruction by wolf- 
like sulphides. 

We learn from practical experience several things which science 
does not tell us, namely : Iron will not cure all cases of chlorosis or 
anaemia, even if they belong to a functional type, but other methods 
must be resorted to at the same time, or separately, for their cure. 
The insoluble salts of iron are better remedies for absorption than 
the soluble salts, because they are not precipitated in the stomach, 
and for this reason reduced iron is the best chalybeate for uncom- 
plicated cases. Besides using iron in this form, we should employ 
laxatives if the bowels are confined, mineral acids, particularly nitric 
and nitro-muriatic, for their effect on the function of the small intes- 
tine and liver, and, in addition, bitter tonics of a more or less simple 
form according to the exigencies of the case ; using quinine if malaria 
seems lurking in the body, simple bitters if the stomach lacks tone, 
aromatic bitters if, from atony of the muscular coats, the digestive 
tract seems sluggish, with a resulting formation and accumulation of 
flatus and digestive juices. 

The preparations of iron best employed in anaemia are the insoluble 
salts just named, such as Quevennes's iron and the carbonate, but 
there are indications which must be regarded as to the salt to be 
used. In many anaemic persons, particularly females, the tongue is 
broad and white, not from coating but pallor, is flabby and torpid 
looking. Under these circumstances the bowels should be kept 
moving by mild purges, and the sulphate or some other astringent 
preparation of iron taken by the patient. In the anaemia of rapid 
childbearing and lactation, cod-liver oil, the hypophosphites and 
phosphate of lime should be used with the iron and quinine in tonic 
dose may be of service in all forms of the disease. With some 
practitioners Blaud's pill is very much used and is made as follows : 

R. — Ferri. sulph. exsiccat. \ ._ .. 

Potas. carbonatis, J * & J* 

Syrupi q. s. 

M. — Ft. in pil. No. xlviii. S. One to three pills three times a day, after 
meals. 

Although it is perfectly true that we have almost no knowledge 
of the manner in which alteratives act in instances of disease, where 
through morbid functional activity enlarged glands or growths 



ANEMIA. 345 

appear, it is evident that they must act upon the trophic nerves or 
directly upon the nourishment of the affected parts. If they are 
used in large quantities they act as depressants to the normal nutri- 
tion of the body, producing primarily a decrease in the vitality of 
morbid growths, so that they melt down and disappear, and they 
may finally so reduce the condition of the healthy tissues as to cause 
sloughs and ulcerations. Whether these changes are due to over- 
stimulation of nutrition — that is, to an excessive trophic change — or 
whether they depeud upon actual lowering of the tone of the parts, 
we know not. One thing we do know, however, and that is, that 
small doses of most of the so-called alterative drugs act as very 
distinct stimulants to the development of normal structures, and in 
no instance do we find this more typically represented than the effect 
which they exert upon the blood. Quite a number of years ago 
Keyes, of New York, emphasized the value of minute doses of mer- 
cury bichloride in syphilitic and other anaemias, and abuudant clini- 
cal observation has certainly confirmed his views. The dose of 
bichloride of mercury in anaemia should be about ^ of a grain. Not 
only will minute doses of the bichloride of mercury act in this way, 
but small amounts of calomel or mercury itself will have such an 
effect. 

Inunctions of very small amounts of mercurial ointment once a day, 
or every other day, in adults and children, will increase the fulness 
and redness of the cheeks and lips, and the number of the corpuscles ; 
the piece of ointment used being no larger than the half a very small 
pea. This treatment will be found of service in cases not dependent 
upon specific taint or scrofula. The marked increase in the nutrition 
of children of a syphilitic taint who are suffering from marasmus, 
under the use of gray powder and inunctions, gives further evidence 
of this fact. 

Arsenic also is of value in anaemic conditions, and may be em- 
ployed in comparatively larger doses than mercury, but, nevertheless, 
smaller amounts thau are usually given in chorea and similar states. 
Osier has shown the value of the drug in anaemia, and so has Barton 
of University College, in England. Any one of the preparations 
maybe employed, but not more than ^ grain of arsenious acid 
should be taken in a day, although more has been used with no less 
benefit to the patient. Most of the drug, under these circumstances, 
is in excess, and is cast off in the urine and faeces unused and wasted, 
and strains and irritates the emunctories of the body during its pas- 
sage through them. 

Bullocks' blood, fresh, or dried and redissolved, may be used in 
anaemia by the rectum in those cases where iron fails, and a change 
of air and diet may often produce a cure which no drug can bring 
about, 

Diet is an important part of the treatment of anaemia. The food 
should be good, well flavored, and varied, as well as easy of digestion. 



346 DISEASES. 

It should contain, as far as possible, the remedies needed by the sys- 
tem, such as bone salts, iron, and alkalies, and should be accompanied 
by some red wine, such as port. 

At present we may conclude that pathology has not found out the 
real cause of these troublesome cases, and that until physiology can 
put its finger upon the most intricate mechanism of blood-making 
with a positive, clear statement of its function and the physiological 
chemistry of the manufacture of haemoglobin, we must remain satis- 
fied to resort to the remedies which experience or common sense tells 
us will be of value to our patients. 



ANAL FISSURE. 

This is one of the most painful affections to which man is suscep- 
tible and requires intelligent treatment, generally by surgical means 
if the result is to be curative, but nevertheless great relief can be 
obtained by the use of drugs. 

The most painful and annoying feature of the lesion is the violence 
of the pain on defecation, which is so severe that any emptying of 
the bowel is impossible except on rare occasions, when the pain is 
concentrated in one effort. 

To relieve this pain and enable the patient to have a fairly com- 
fortable stool, nothing is so good as an iodoform suppository con- 
taining 2 to 5 grains of the drug. Iodoform being a local anaesthetic 
the passage takes place almost without the patient's knowledge. If 
much spasm of the sphincter is present extract of belladonna, J 
grain, may be added to each suppository. For the cure of the fissure 
a drop of strong carbolic acid may be applied to the spot and a 
lotion of tannic acid, glycerin, and water used if haemorrhoids are 
also present. Ringer highly recommends the application to the 
fissure, by means of a brush, of a solution of bromide of potassium, 
1J drachms to 1 ounce of glycerin. In order that the passages may 
be soft and yet the patient not be purged, sulphur should be given in 
the dose of one teaspoonful every night, or, if this cannot be used, 
castor-oil may be given. 

The best way to give the sulphur is by combining it with pow- 
dered cinnamon or aromatic powder. Sometimes relief is obtained 
by the use of flexile collodion painted over the part. 



ANEURISM. 

The treatment of aneurism by drugs is unfortunately not very 
successful but is at least worthy of trial in all cases. Vascular dis- 
ease resulting in such a lesion depends upon so many causes which 



ANGINA PECTORIS. 347 

may modify the treatment that the history of the case should be well 
borne in mind. The most common causes are syphilis, rheumatic 
taint, and traumatism, and very often injury is superimposed upon 
one of the systemic taints named. Whatever the cause of the disease 
may be iodide of potassium is par excellence the remedy most apt to do 
good, and it will nearly always give relief even if it does not cure. 

The doses should be large, 10 to 20 grains three times a day, if the 
patient will bear them, and the prognosis under this treatment is far 
more favorable if the cause be syphilis than if the disease be idiopathic 
or traumatic. For its successful use the recumbent position must be 
insisted upon and the patient kept quietly in bed, chauging his posi- 
tion as little as possible and confining himself to the most simple and 
easily digested diet with entire avoidance of all stimulating sub- 
stances, either in the way of food or drink. If the heart be excitable 
and irregular and the vascular system irritable with a high arterial 
tension, the circulation must be quieted by small doses of veratrum 
viride, say l^or 2 drops twice or thrice a day, but digitalis is not to 
be employed since it increases the strain upon the aneurismal sac, 
although it does quiet the irregular heart-beat. Aconite may also 
be used with care, but is inferior to veratrum viride. If the pain be 
very great, and it often is severe, particularly at night, opium is 
indicated and sleeplessness should be allayed, not by full doses of 
morphine, but of morphine and chloral ; or, better still, croton- 
chloral mixed so that the patient receives J grain of morphine and 
10 grains of croton-chloral in pill at bed-time. All other attempts 
to cure aneurism by the use of other drugs, unless syphilis indicates 
mercury, are useless when the lesion is thoracic or abdominal, and 
where it occurs in the extremities, as in popliteal aneurism, surgical 
measures are to be resorted to as the chief means of cure. If dyspnoea 
in thoracic aneurism is marked slight inhalations or "whiffs" of 
chloroform are useful. 

As we do not know how alteratives act, other than that they 
govern nutrition, we cannot explain the value of iodides in aneurism. 



ANGINA PECTORIS. 

As the condition which exists in angina pectoris, so far as path- 
ology and morbid anatomy are concerned, is unknown, it is impossible 
for us to establish any scientific basis for the employment of drugs in 
the cure of this disease. The nearest approach to any such attempt 
is that first proposed by Lauder Brunton and is but another evidence 
of the value of studies upon animals, since he argued that as he 
found nearly all attacks of angina pectoris were associated with 
vascular spasm, that vascular spasm might be the cause of the par- 
oxysm, and that a drug decreasing this spasm would be of service in 



348 DISEASES. 

consequence. Whether the vaso-motor excitement is "cause or 
effect" we do not know, but we do know that drugs which decrease 
arterial pressure often give relief in the attack if it be associated with 
high pressure, and even may eventually produce a cure. Further 
than this, we know that nitrite of amyl, nitrite of sodium or potas- 
sium, and nitroglycerin, are of this class. All of these drugs lower 
blood pressure at once and powerfully, but the nitrite of amy] and 
nitroglycerin are the best remedies for the attack itself, and the nitrite 
of potassium or sodium for the intervening periods, or where the 
paroxysm is prolonged. The reason of this lies in the fact that the 
sodium and potasssium salts are more stable than the other two 
compounds, are more slowly broken up in the body and, therefore, 
more prolonged in their effects. In an attack a few drops of the 
nitrite should be given by inhalation from a handkerchief or the 
nitroglycerin can be used in the dose of 1 drop of a 1 per cent, 
solution by the mouth. The dose of the sodium and potassium 
nitrites is 3 grains three times a day but all these drugs are useless 
unless the arterial tension is high and the heart throbbing or irregular 
in its exercise of power. If vascular relaxation is present they should 
be supplanted by stimulants, such as alcohol, in full close, in warm 
water. 

Digitalis may be given during the attack to stimulate the heart, if 
it is weak, and between the attacks to improve its condition. The 
writer has found 20 grain doses of antipyrine of great service in 
some cases. Ether given hypodermically is often of service, but 
Hoffmann's Anodyne may be used instead of ether when it is admin- 
istered by the mouth. 

If the nitrite does not relieve the paia, or if it cannot be used, 
morphine must be given hypodermically in the dose of \ to \ 
grain but it should never be given by the mouth, as its absorption 
will be too slow and its effects will come on after the pain has ceased. 

In the form occurring in nervous females, 1 drachm of ether in 
water or capsule will often abort the attack, or if the paroxysm 
be caused by dyspepsia, and if the stomach be overloaded the suf- 
ferer may be relieved by the stomach-pump. The cure of the 
patient rests upon the elimination of all causes which can possibly 
produce a nerve storm of cardiac irritability and in the administra- 
tion of arsenic in full dose for long periods of time. Phosphorus is 
another remedy which is of undoubted value and should always be 
tried in the dose of jj^ grain three times a day after meals. 

The diet should be moderate and easy of digestion and salads, 
lobster and similar things abandoned. If the patient is inclined to 
take exercise of a violent character he must be quieted, but some exer- 
cise must be insisted on if it is possible. 

Tonics, fresh air, freedom from mental worry and avoidance of 
cold are also necessarv. 



APHTHOUS STOMATITIS. 349 

Cocaine has been highly recommended for the cure of angina 
pectoris, but is as yet untried, except in a few cases. 



ANOREXIA. 

Anorexia is only a symptom of disease, generally associated with 
debility or other systemic cause, such as fever or many other exhaust- 
ing diseases. 

It is best treated by a careful diet, the use of the bitter tonics, such 
as gentian, cardamoms, and the mineral acids, or by the use of one of 
the following prescriptions : 

R. — Acid, arseniosi gr. J. 

Ext. nuc. voiri. ....... gr. iv. 

Quin. sulph. ....... gr. xx. 

M. — Ft. in pil. No. xx. S. One t, d. after meals. 
Or 

R. — Tinct. cinchonse comp. f^ v j» 

Acid, muriat. dil. . . . . . . f^ss. 

M. — S. Dessertspoonful three times a day, after meals, well diluted with 
water. 

For the use of other bitter tonics see Columbo, Quassia, Chamo- 
mile, Cardamoms, and Strychnine. 

None of these drugs are suitable if there is any acute irritation or 
inflammation of the stomach or intestines. (See Indigestion.) 



APHTHOUS STOMATITIS. 

This annoying aifection is most commonly seen in children, and 
is characterized by the appearance on the tip and sides of the tongue, 
lips, and lining membrane of the mouth of small white spots which 
sometimes have a reddened zone around them. They often extend 
through the alimentary canal and produce much systemic disturbance. 

The best treatment, if the kidneys are not acutely inflamed, is the 
use of the following prescription, which largely depends for its value 
upon the potassium salt used. 

R. — Potas. chlorat. . . . . . . . gj. 

Tinct. myrrh. ....... gtt xx. 

Elixir calisayse ....... f^iij. 

M. — S. Teaspoonful in water every 4 hours. 

As the chlorate of potassium is eliminated by the saliva, it not only 
does good when taken into the mouth, but is active all the time that 
it is being eliminated. The same preparation may be used as a 
mouth-wash if the stomach is disordered. Often constipation will 



350 DISEASES. 

exist and it should be removed by salines or by rhubarb in the form 
of the aromatic syrup. Another remedy which is very efficient in 
stomatitis is borax, used as a mouth-wash, in the strength of 10 to 
15 grains to 1 ounce of water and honey, as follows : 

R. — Sodii boratis gr. xxx. 

Mel. purificati f giij. 

Aq. • • q. s. f |iij. 

M. — S. To be used on a swab or as a mouth-wash every four hours. 

This may also be used internally in adults. 

If the liver is at fault and is torpid nitro-muriatic acid is useful, 
and when the spots do not readily yield to treatment they may be 
touched with the tip of a stick of silver nitrate, which, while it is 
momentarily painful, is very efficacious. 

Nearly always with this disease in childhood there is considerable 
fever, vomiting, and wakefulness at night, with fretfulness and crying 
during the day, and total refusal of food, not because hunger is absent, 
but because the food hurts the mouth and is rejected with a cry of pain 
as soon as it touches the lips. The food should be very soft, milk 
toast for older children, or milk with lime-water in it in large amount 
for infants fed by the bottle. A warm foot-bath at night is often neces- 
sary to produce rest, and 10 drops of sweet spirit of nitre thoroughly 
diluted may be given with advantage to a child of one or two years. 
If the irritability of the nervous system is excessive, bromide of 
sodium or potassium in the dose of from 1 to 10 grains, according 
to age, three times a day, is of service, and may be added to the 
mixtures already named ; or better still, given alone. 

After the attack is past tonics and a carefully selected diet are 
generally necessary. 

APOPLEXY. 

When a person suffers from a stroke of apoplexy the chief aim of 
the physician must be to lower the blood pressure, and so to decrease 
haemorrhage, and as the blood pressure is nearly always excessive 
under these circumstances its reduction may be considered as a routine 
treatment. If the person be at all full-blooded copious venesection is 
to be employed, any one of the veins in the arm on its anterior surface 
being most convenient. (See Venesection.) At least one pint should 
be withdrawn and the condition of the pulse carefully noted. If 
bleeding is impossible veratrum viride or aconite must be used to 
lower blood pressure, the latter in full dose, 5 drops of the tincture. 
Hot mustard plasters must be applied to the feet or a warm mustard 
foot-bath be used, if this practicable. Ice in an ice-bag or wrapped 
in a towel may be applied to the head, and if vomiting comes on care 
must be taken that the stertorous breathing does not draw particles 



APOPLEXY. 351 

of the food vomited iDto the lungs. Sometimes croton oil, 1 drop, 
placed on the tongue may cause a depletaut catharsis, or jr grain of 
elaterium may be used. The head must be kept high and the feet 
low down. These are the methods to be used immediately after the 
rupture of the bloodvessel in the attack. The object to be sought, 
after the " stroke" has occurred and the haemorrhage has ceased, is 
the removal of the extra vasated blood, the restoration of function 
in the paralyzed parts, and the prevention of secondary lesions con- 
sequent upon inflammation of the brain as a result of the injury to 
its substance. If the patient survives the attack no drugs should be 
used, save arterial sedatives, for one or two days, until the clot in 
the ruptured vessel has become firmly fixed, unless symptoms of 
meningitis arise, when these drugs must be pushed and opium and 
calomel administered in small antiphlogistic doses, J grain of each 
every four hours. Meningitis and cerebritis rarely occur if the 
veratrum viride or aconite is properly used. After the clot is 
firmly formed and has plugged the bloodvessel we may proceed to 
take measures for its absorption, the chief of which consists in the use 
of iodide of potassium in as large doses as the patient will bear with- 
out the production of iodism. This drug should not be resorted to 
until several days, or even two or three weeks have elapsed. 

Mercury in small doses may also be given. 

In order that the muscles of the extremities may not waste and 
become useless from disuse, passive exercise, rubbing, and, if possi- 
ble, massage must be resorted to. Electricity may be applied to them 
in the form of the slowly interrupted current and strychnine may 
be used hypodermically, or by the mouth, as a stimulant to the 
trophic centres in the spinal cord. None of these measures are to 
be employed if any inflammation exists in the brain, as they will 
increase the cerebral disorder, and at least three weeks should elapse 
after the attack before they are resorted to. 

Electricity applied to the head to relieve the lesion is useless, as 
the current does not go through the brain, but around the skull by 
means of the scalp. 

A very careful diet is to be maintained. Meats are to be used 
very sparingly, the bowels maintained in perfect regularity, and no 
wines are to be taken nor any stimulants used, lest they cause a 
second rupture of the weakened vessel in the brain. 

Apoplexy must be carefully differentiated from acute alcoholism 
and opium poisoning, which it much resembles. (See Alcohol.) 

If respiration fails, nothing can be done with much advantage, 
but belladonna or strychnine may be given hypodermically. The 
use of electricity to stimulate the diaphragm to contraction is a rem- 
nant of senseless medical practice and particularly useless in apoplexy. 
(See Asphyxia.) 

Above all things stimulants are contra-indicated, even though the 
pulse fails, as they increase the haemorrhage into the brain. 



352 DISEASES. 



ASPHYXIA. 

With the advent of the production of artificial anaesthesia by the 
use of certain chemical compounds the importance of this subject 
necessarily became enormously increased, and no one can doubt 
that the majority of cases of arrested respiration depend for their ex- 
citing cause upon some such agency, or to the inhalation of noxious 
gases. It is of the greatest importance that a clear idea of the neces- 
sities of the case be before the physician under such circumstances, and 
that his action be one of rapidity and clearness so far as the ultimate 
result which he seeks is concerned. By some curious fallacy of teach- 
ing the greater part of the profession have been taught to faradize the 
diaphragm into contraction with the rapidly interrupted electrical 
current, by the application of one pole over the phrenic nerve in the 
neck and the other over the abdomen. It requires but little thought 
to show that such a method is ludicrous in the extreme, for by using 
such a current on any muscle, we produce a condition of spasmodic 
contraction or tetanus. Everyone knows that the diaphragm re- 
laxed by paralysis or contracted by spasm, so long as it is immovable, 
is equally harmful to the patient. If any current is to be employed, 
let it be that which is slowly interrupted and which will alternately 
contract and relax this important respiratory muscle. There can 
be little doubt that the rapidly interrupted current has caused per- 
sons to renew their respiratory movements, but in these cases the 
result has been dependent almost certainly on the reflex excitability 
of the cells in the spinal cord and medulla rather than on an action 
upon the phrenic nerve. If such an action is required, the poles of 
the battery may be swept over the body so as to cause peripheral 
irritation. 

The absurdity of the application of the rapidly interrupted current 
to the phrenic nerve is not alone dependent upon the points we have 
named. It has been proved by careful observation on the part of 
Dr. Martin and the author that the application of the electrode over 
the phrenic nerve in the neck may cause cardiac arrest through dif- 
fusion of the current to the vagus nerve, and Griswold reached con- 
clusions of an identical character in the year 1885. 

If electricity is used, it should be employed solely as a peripheral 
irritant, with the object of arousing the patient, as would a dash of 
cold water, 

The question at once arises as to the best thing to do when such an 
accident occurs. If the arrest has occurred when the patient is under 
chloroform, his head should be lowered and the feet raised almost 
perpendicularly. The neck should not be extended but held in the 
normal position, so that the chin is somewhat shot forward and at 
a right angle to the body line. If the neck be extended the glottis 
does not open as well when the position named is assumed. While 



ASPHYXIA. 353 

one assistant supports the head, another should use artificial respir- 
ation by Sylvester's method, and it will then be readily seen that 
there is an increased volume of air passing in and out of the chest. 
The drawing forward of the tongue is not so important as is imagined, 
unless it is turned with its tip toward the glottis. The use of ammonia 
as a rapidly acting respiratory and cardiac stimulant, when given in- 
travenously into the leg, may be resorted to, and dashes of cold and 
hot water should be employed, not only for their excitation of the 
peripheral nerves, but also for the purpose of keeping the bodily 
temperature from rising above or falling below the normal line, the 
latter danger being the most pressing, of course. The hypodermic 
injection of ether during asphyxia from ether anaesthesia is a ridicu- 
lous therapeutic attempt, for if the system and respiratory centres 
are so depressed by the ether already taken into the blood through 
the lungs as to have their functions in abeyance, why should we add 
still greater depression by injecting more of the same drug? Let 
everything that is done be born of sense and though tfulness of the 
exact action and result desired, and let nothing be done simply be- 
cause some other person has done it, great though he may be in the 
practice of the healing art. Measures for the relief of persons suffer- 
ing from any malady depend not upon empirical laws, but upon the 
good common-sense of the physician in charge, even if the measure 
is a most revolutionary one in character. 

When practising artificial respiration in cases of asphyxia, Syl- 
vester's method should always be employed. This consists of laying 
the patient on some hard, flat surface, kneeling above his head, and 
then, after grasping the arms at the elbows, to bring them upward 
and outward, so that they follow the plane on which the body is ex- 
tended. This movement cause expansion of the chest or inspiration. 
After a moment's, pause the arms are lifted up and brought toward 
one another, and then, while still approximated, pushed down to 
their original position upon the floating ribs upon which they are 
pressed. This last movement drives out the air from the chest, or 
causes expiration. These movements should be at the rate of from 
sixteen to twenty per minute, about normal respiration, and be per- 
sisted in for at least forty-five minutes if necessary. While they are 
being carried on the patulousness of the upper air-passages is to 
be maintained. In some researches made by Dr. Martin and the 
writer, the following rules regarding the position of the head, neck, 
epiglottis, and tongue were formulated : 

The fingers are passed behind the angles of the lower jaw, and the 
latter is pressed forward ; this elevates the epiglottis and the base of 
the tongue about a quarter of an inch from the post-pharyngeal wall. 
Extending the head and pushing it forward so that the neck makes 
an angle of forty-five degrees with the plane of the table, draws the 
base of the tongue and the hyoid bone far forward, this motion being 
at the same time imparted to the epiglottis, so that the latter stands 

23 



354 DISEASES. 

upright and is separated from the posterior wall of the pharynx by 
an interval of about an inch. By tightly closing the jaw the antero- 
posterior space is still further increased. 

The epiglottis may prevent free entrance of air to the lungs even 
though the tongue is pulled forward. Any means which accom- 
plishes the anterior projection of the hyoid bone immediately and 
infallibly raises the epiglottis and the base of the tongue, and the 
hyoid bone may be made to project anteriorly by direct pressure 
upon its cornua, by direct pressure or traction applied to the tongue 
far back behind the anterior half arches of the palate and by the 
action of gravity in the abdominal decubitus, or by extension of the 
head upon the neck, but flexion of the neck with extension of the 
head upon the neck does away with the epiglottis as an obstructing 
factor as completely as any other posture. 



ASTHMA. 

Asthma is one of the most difficult diseases to treat successfully 
that the physician has to deal with. 

The disease in all its forms depends upon interference with the free 
entrance and exit of the air in the lungs, and this is generally if not 
always dependent upon a spasm of the muscular fibres in the walls 
of the bronchial tubes, although it has been asserted to be due to a 
sudden swelling or hyperemia of the bronchial mucous membrane. 
Both of these states are probably present in varying degree in all 
cases. 

The spasm has been proved by Louget, Williams, Romberg, and, 
more important than all, by Paul Bert and Bierner to be due to a 
neurosis of the pneumogastric or vagus nerve, while the swelling of 
the mucous membrane has been seen by Stoerk and others. This 
has formed two schools of teaching concerning the pathology of this 
disease when a little attention to the physiology of the subject would 
at least show that no difference need exist, the vagus nerves govern- 
ing not only the muscular fibres but also the bloodvessels of the 
bronchial tubes. The discovery of Michaelson that injury of the re- 
current laryngeal nerves causes catarrhal inflammation of the bron- 
chial tubes, particularly of the upper lobes, renders the analogy be- 
tween acute asthma and laryngeal spasm which has been spoken of 
by many writers still more interesting. 

One other step remains for a thorough understanding of the manner 
in which the disease is produced. Gastric, dyspeptic, or intestinal 
asthma arises from indigestion, as its name implies, and is caused by 
the irritation of the afferent filament of the vagus in the walls of 
the stomach and intestine, thereby causing reflexly a contraction and 
hyperemia of the bronchial tubes. 



ASTHMA. 355 

Having now obtained some idea of the cause of an attack, let us 
turn to the treatment of the affection. 

By far the most serviceable remedy in asthma as every one knows, 
is belladonna which, as has been pointed out when that drug w T as 
studied (see Belladonna), exercises in medicinal dose a decided sedative 
and depressing influence on the peripheral filaments of the vagus 
nerves not only so far as the heart is concerned, but also upon bron- 
chial secretion, which is always diminished by the drug, probably by 
its vagal influence. 

It is evident therefore that the use of belladonna or atropine 
although originally employed in an empirical manner, is really based 
upon rational ideas, and as the physiological action of stramonium, 
hyoscyamus, and similar members of this group is identical with bel- 
ladonna, their influence for good is also explained. The experiments 
of Ott proved that lobelia is a peripheral pneumogastric depressant, 
and those of Rosenthal and the author likewise found that tobacco 
has a similar effect. The same is also true of nitrite of amyl and 
the other nitrites which also relax unstriped muscular fibre. We 
have before us, therefore, a list of the most efficacious and best anti- 
asthmatics, all of them being depressant to the peripheral vagi. 

The other remedies commonly employed are chloroform by inha- 
lation, which relaxes the spasm of muscular fibre by its local influ- 
ence, and morphine which acts as a nervous sedative, prevents reflex 
irritation and quiets the patient, acting at the same time as a heart 
stimulant and unloading the engorged cardiac cavities. The relief 
obtained by the inhalation of the fumes of nitrate of potassium, See 
asserts, depends upon the formation of the protoxide of nitrogen and 
carbonic acid gas, which act as local ansestbetics. 

The practical treatment of an attack of asthma consists in the use 
of morphine hypodermically in the dose of -J- to J grain alone, or 
in combination with atropine. Cigarettes made of paper soaked in 
a solution of nitrate of potassium and belladonna may be used, (see 
formula, Belladonna), or they may be made in the following manner : 

$. — Fol. belladonna? ....... gr.vj. 

Fol. hyoscyami . . . . . . . gr.iij. 

Fol. stramonii gr.iij . 

Ex. opii gr.J. 

Aq. lauro cerasi . . . . . . . q. s. 

These various leaves are broken up like commercial tobacco, and 
moistened by adding the cherry laurel water which should contain the 
opium. Finally a wdiole leaf soaked in the same fluid is used as a 
cover, or a piece of cigarette paper may be employed in the same 
manner. 

The use of amyl nitrite by inhalation, 3 to 6 drops on a handker- 
chief, is invaluable in most cases, and it never fails to relieve the 
spasm. Owing to the engorgment of the heart consequent upon the 



356 DISEASES. 

embarrassment of respiration, it must be used with care, and in one 
or two instances has proved dangerous. 

Sometimes tobacco may be smoked, and is particularly efficacious in 
those who are not accustomed to its constant use. 

Lobelia when employed should be used in full emetic dose (1 
drachm) in the form of the tincture if an attack is present. If an 
attack is feared 10 drops of the tincture every four hours may be 
given if the heart is in good condition. 

The curative treatment of asthma rests upon the use of iodide of 
potassium to a very large extent, and in the careful regulation of the 
diet and bowels, particularly if the trouble seems to be dependent 
upon indigestion. As the attacks are generally nocturnal the evening 
meal should be taken early, be light and easily digested, and tea and 
coffee be avoided at this time. The patient should avoid dusty 
streets and live in the open air as much as possible, and a damp 
atmosphere is usually preferable to a dry one, provided it is not too 
cold. This rule is subject to many variations, and each case will be 
found a law unto itself, and must try different climates until the 
proper one is found. Arsenic may be used, particularly if the mucous 
membranes are below par, and a dose of bromide of potassium or 
sodium, 30 grains, half an hour before retiring to bed, may be of 
service. Grindelia robusta is largely used as a prophylactic in the 
dose of 10 to 30 minims of the fluid extract three times a day. 

Lobelia may also be used in the form of the tincture, 10 drops 
three times daily. 

Compressed and rarefied air are of service and inhalations of oxy- 
gen are valuable if the cyanosis is extreme. 

In some cases the presence of nasal polypi or other irritations of the 
air-passages causes the disease to appear and must be removed before 
a cure can be attained. In other instances arsenical wall papers are 
at fault. 



BED-SORES. 

Bed-sores depend upon disturbances of nutrition resulting from 
pressure exercised in such a manner that the local circulation is inter- 
fered with at a time when the vitality of all the tissues is depressed 
by disease or injury. In most instances the part involved becomes 
chafed by creases in the sheets, by crumbs of food, or by moisture 
from the discharges of the rectum and bladder. 

The chief thing to be done is to prevent the trouble by careful 
nursing and cleanliness, which must be supplemented by measures 
devoted to the hardening and improving of the skin covering the 
parts where the sores are apt to appear, as over the buttocks and 
sacrum. To permit of a good supply of blood the patient should be 
turned on one side or the other every few hours and the skin rubbed 



BILIOUSNESS. 357 

thoroughly with a dry towel to cause a healthy transudation and 
absorption of the nutritive juices. Salt and whiskey, 2 drachms to 
the pint, may be rubbed over the skin, or tincture of catechu and the 
dilute solution of the subacetate of lead applied to harden it. If this 
is not used, a mixture of alum and spirit of camphor is useful, made 
by adding 1 ounce of powdered alum to the whites of 4 eggs and 
mixing this with 2 ounces of the camphorated spirit. Where the 
skin is very red and angry looking, but still intact, a solution of 
nitrate of silver of the strength of 20 grains to 1 ounce is to be 
thoroughly painted over the spot. All these remedies act in harden- 
ing the skin through their astringency, or by acting as sedative astrin- 
gents to the inflamed capillaries of the part. 

When a bed-sore is developed measures must be taken for its 
cure and the prevention of its spread. With this object in view 
the body must not rest on the part affected if it can possibly be 
avoided, and in order that the sore may be protected and the pressure 
equalized, a large piece of soap plaster with its edges deeply incised 
to make them pliable, should be applied after the sore has been thor- 
oughly washed out by means of a swab or syringe with a 1 to 5000 
solution of bichloride of mercury and dusted with iodoform. Some- 
times large squares of lint heavily covered with zinc ointment are 
serviceable in lieu of the soap plaster. If the sores spread and 
burrow through the parts the sinuses should be freely opened and 
irrigated, all dead tissues being cut away to avoid sepsis. 

Nitrate of silver in the strength of 20 grains to 1 ounce may 
also be used as the patient recovers, if the ulcers seem sluggish and 
a smooth slip- sheet should always be placed under the buttocks. If 
possible, supportive measures and an increased amount of food should 
be given if the sloughs are large. 



BILIOUSNESS. 

This is a term used to designate a state which presents different 
symptoms in different cases, but always includes languor, headache 
or dizziness, perhaps some yellowing of the skin and conjunctiva, 
and a general sense of atony, mental depression, and discomfort. It 
depends not upon an excessive secretion of bile, but upon some 
perversion of its function or secretion, or its retention in the bile- 
ducts. Further than this, most of the symptoms do not depend 
directly upon the changes in the bile, but upon failure of proper 
digestion in the stomach and intestine, coupled with the development 
of irritative decomposition-products of various kinds. The stomach, 
intestine, liver, pancreas, and their juices all form a complex inter- 
woven chain of function in which if one link breaks the entire chain 
becomes disturbed. The entrance into the stomach of certain food- 



358 DISEASES. 

stuffs, which are either ill-prepared or improper for gastric digestion, 
rapidly causes the development of active fermentation and a split- 
ting up of these bodies, with the formation of lactic and butyric 
acids, which irritate the gastric mucous membrane and thereby bring 
about a faulty gastric secretion of mucus, which aids in making still 
further trouble. By the same means the circulation of the stomach 
is disturbed and becomes abnormal, and the intestine, liver, and 
pancreas receive reflex irritation to which they are not normally ex- 
posed. Further than this, the irritated stomach fails to convert its 
contents into peptones and the general features of chyme, and too 
early drives out into the duodenum a mass of semi-digested and fer- 
menting material, utterly unfit for intestinal digestion and absorption, 
thereby disordering the functions of these parts still further at a time 
when they are not prepared for the reception of any food. The secre- 
tion poured out by the different glands varies from the normal, the 
alkaline juices are not able to overcome the normal acid of the gas- 
tric juice plus the lactic and butyric acids, and finally the reaction of 
the intestine becomes acid instead of alkaline with resulting irritation 
and secretion of morbid juices and mucus. The trouble while exist- 
ent in the stomach gives rise to headache and discomfort, a bad taste 
in the mouth, and perhaps pain, and is followed by fever, languor, 
jaundice, and flatulence when the intestine is affected. The cause of 
these symptoms rests upon the fact that while gastric juice and bile 
are antiseptic, pancreatic juice mixed with food undergoes rapid de- 
composition with the development of products of decomposition 
such as skatol and indol and a large number of poisonous alkaloids. 
Normally these are not allowed to form owing to the presence of 
antiseptic bile, which also hurries on the absorption of the food, but 
if the bile is retained in its ducts its secretion is impaired and its 
constitution altered by the disorder of the liver, which results reflexly 
from the gastric and intestinal irritation. Unfortunately the com- 
plication does not cease at this point, for the liver in health has other 
functions to fulfil, one of the most important of which is the arrest 
and destruction of all poisons of an organic character which come 
to it from the stomach and bowel. Not only are decomposition- 
products destroyed by it, but all the vegetable alkaloids are rendered 
innocuous if present in ordinary amounts. 1 The disorder of hepatic 
function, therefore, permits the entrance into the general circulation of 
these substances, which are very various as regards their powers and 
effects. Thus Brunton has pointed out that one of these compounds 
closely resembles curare, in that it poisons the peripheral ends of the 
motor nerves, and thereby is at least partly responsible for the mus- 
cular relaxation and languor often seen in patients suffering from 
so-called " biliousness." Other substances act as do digitalis, atro- 

1 See studies of Schiff, Lautenbach, and many others, including Ludwig and Schmidt- 
Mulheim. 



BILIOUSNESS. 359 

pine, muscarine, and picrotoxin, and the number of these various 
compounds is indefinite. 1 

It is impossible to give space to a further consideration of these 
poisons, but what has been said shows clearly that " biliousness " only 
expresses a state in which absorption of the bile is not the cause alone, 
but that other poisons are at work. The methods of treating bilious- 
ness are therefore not to be considered as depending upon some 
regular routine, but upon a study of the case and its symptoms. 

Very frequently after several days of minor discomfort, the attack 
culminates in a severe sick headache, after which vomiting comes on 
and relief is obtained almost at once. Such patients can generally be 
relieved in the very first part of their discomfort by emetic doses of 
ipecac or apomorphine, 30 to 60 grains of the former or -^ grain of 
the latter hypodermically. The manner in which this treatment does 
good is very evident. It compresses the liver and expels inspissated 
bile by the compression exercised by the abdominal walls and dia- 
phragm in the effort of vomiting and thoroughly excites to normal 
secretion the torpid glands of the stomach aud intestine. 

The vomiting also rids the stomach of the fermenting masses and 
bacteria contained in them and renders the alimentary canal pure. 
This purity may be increased by draughts of warm water, or water 
containing a few grains of bicarbonate of sodium or salicylic acid, 
between the paroxysms. 

When it becomes evident that an attack is about to begin, that is, 
when constipation, slight drowsiness or languor after meals show the 
tendencies present, one of two drugs should be used, namely, either 
podophyllin if the stools be dark, or calomel if they be light colored. 
One-sixth graiu of the former to an adult is generally enough, or 1 
grain of calomel divided into six powders, one of which is to be taken 
every 15 minutes, is a good dose, to be followed in four hours by 
a saline. If the attack is sudden in its onset no time is allowed for 
these hepatic stimulants, and a saline should be used in a good sized 
dose at once, not because it causes a flow of bile but because it sweeps 
the poisonous matters out of the gut before absorption can occur and 
aids in restoring the normal intestinal alkalinity. 

The prevention of "biliousness" depends upon the maintenance 
of a normal, easily digested diet, upon the formation and excretion 
of normal bile, and the prevention of fermentation and decomposition 
in the alimentary tract. 

The term " normal diet" is a very elastic one and varies with each 
case. While rules generally hold good that certain forms of food are 
good or bad, easy of digestion or difficult of assimilation, it neverthe- 
less remains a fact that many of the simplest foods are capable of 
acting as poisons. A large number of persons cannot take milk or 

1 See the researches of Schweringer, Zuelzer and Sonnerscheim, Bence Jtfnes, Dupre, 
Borch and Fasbender, Brieger, Schmiedeberg and Harnach. 



360 DISEASES. 

eggs because their digestion of these substances is faulty, and the writer 
is cognizant of one case where lobster salad can be eaten at bed-time 
without discomfort while an egg at breakfast will cause a severe 
headache or pain in the belly. Rules as to diet must not be " iron- 
clad " but based on observation. 

By far the best means of maintaining hepatic activity in cases 
where this organ is torpid is horseback exercise, particularly on a 
trotting horse, as the jolting by its movement of the liver keeps the 
digestive chain of functions active and prevents the secretions from 
becoming clogged. Along with this exercise massage of the hypo- 
chondrium and belly walls is useful and the movement of stooping 
over, bending from side to side, and bending backward with the feet 
close together is of value. Coffee is often the cause of biliousness 
because of its oil. 

The use of pure red undiluted nitro-muriatic acid in these cases 
in the dose of 3 drops three times a day is invaluable, and the fluid 
extract of stillingia in the dose of 20 drops is of service, as is also 
the solid extract of euonymus in the dose of 3 grains. Five-grain 
doses of chirata are also useful in hepatic atony. 

The knowledge of the action of many of the poisonous materials 
formed renders it possible for us to relieve the patient by other means 
than those which may be generally resorted to when the attack is 
present. Thus if the pupils are dilated, the skin hot and dry, the 
eyesight dim, and the pulse rapid, the alkaloid producing these 
signs of atropine poisoning may be antagonized by opium in small 
dose, or if the pulse be slow and full, the arterial tension high, and 
there is throbbing in the head with frontal headache the alkaloid rep- 
resenting digitalis may be antidoted by the use of aconite. If nerv- 
ousness and irritation ensue the bromides and chloral may be used. 

For some unknown reason the use of caffeine, in the headaches 
of biliousness, nearly always makes them worse, particularly if the 
headache is due to over-indulgence in coffee. 

If the face is flushed a mustard plaster or cup to the nape of the 
neck may be used, and a hot foot-bath is often of service. 

In cases where the bilious attacks are associated with catarrh of 
the stomach, intestines, and bile ducts, chloride of ammonium, in 5 
grain doses three times a day, is very useful, as is also the protiodide 
of mercury, when triturated with sugar of milk, in the dose of -g 1 ^- to 
^o of a grain three times a day. 



BLEPHARITIS. 

Blepharitis is divided clinically into an ulcerative and non-ulcera- 
tive variety. The indication of prime importance in the treatment 
of this affection is the removal of the scars and crusts before the 



BOILS. 361 

application of the local remedies. This may be accomplished by the 
use of alkaline solutions, bicarbonate of sodium, or borate of sodium 
(grains 8 to the ounce) or a 5 per cent, solution of chloral, as recom- 
mended by Gradle. The salves which have met with the greatest 
success are Pagenstecher's ointment (yellow oxide of mercury 1 grain, 
vaseline 1 drachm), dilute citrine ointment, pyrogallic acid oint- 
ment, or a 3 per cent, milk of sulphur ointment, to which resorcin may 
be added. The latter application is useful in the squamous variety 
alone. In the ulcerated form, if the crusts are tenacious, these, as 
well as the stunted cilia, must be removed with forceps, and yellow 
oxide of mercury salve, or some similar application, applied. Excel- 
lent results follow touching the crater-like abscesses, which exist in 
edges of the lid, with nitrate of silver. If there is an accompanying 
conjunctivitis a boracic acid lotion is suitable, while, under any cir- 
cumstances, obstruction of the lachrymal duct, a frequent accompani- 
ment of the disease, must be removed, and the nasal passages ex- 
plored for any chronic inflammatory condition. The relation between 
this disease and the presence of refraction errors demands the correc- 
tion of the latter, should they exist, before a hope for cure may be 
entertained. 



BOILS. 

Boils are dependent upon an impoverished state of the system, due 
to several causes, or more rarely to some local trouble with the skin, 
as in oil or paraffine workers. 

Their constitutional treatment rests upon the use of fresh air, cod- 
liver oil, iron, arsenic, phosphate of sodium, and, if any boils are 
present at the time, the use of the sulphide of calcium in the dose 
of y 1 ^- grain every five hours. The sulphide of calcium or, more 
properly speaking, sulphurate of calcium, hastens the maturation of 
boils and prevents the formation of new ones, but is useless in the 
boils of diabetes, according to its original user, Dr. Ringer. 

The local treatment of boils may be divided into the abortive and 
curative method. The abortive method consists in painting the 
inflamed spot, when it first begins, with a solution of gun-cotton 
(collodion) and renewing the coat hour after hour until a heavy con- 
tractile covering is formed. 

If pus forms under this it may be absorbed, if left alone, but if 
this does not occur then the boil must be opened under antiseptic 
precautions and properly dressed. A strong solution of nitrate of 
silver is also very useful at the very beginning of the formation of a 
boil, painted over the part in the strength of 20 grains to the ounce. 
The other local applications consist in the use of the extract of 
opium or belladonna over the part to relieve pain and decrease the 
inflammation. 



362 DISEASES. 

Poultices may also be used to relieve the sensation of tenseness 
and mature the boil, and should contain sweet oil and laudanum. 
Ringer recommends the employment of alcohol and camphor over 
the skin in the early stages, which is then wiped dry and camphor- 
ated oil smeared over the part, and Stelwagon uses the following : 

R.— Ichthyol . . gj. 

Emplast. plumbi gij. 

Emplast. resinae . . . . . . . zj. 

M. — S. Apply to the part. 

He also approves of the injection of a 5 per cent, solution of car- 
bolic acid into the apex of the boil if its formation is assured. 



BREASTS, INFLAMED. 

Mastitis is, from a medical point of view, readily treated. Lacta- 
tion should at once cease and the breast be dressed by the use of a 
sponge compress, underneath which belladonna ointment is to be 
copiously smeared. Belladonna is useful both before and after very 
acute inflammation has set up, and should be persisted in for twenty- 
four hours. 

At the same time that these measures are resorted to, the circulation 
should be thoroughly impressed by aconite or veratrum viride and 
the use of mild or saline purges. If the milk persists in forming it 
must be removed by the breast-pump. For the surgical treatment 
of mastitis the reader should refer to the books on such subjects. 



BRIGHT'S DISEASE, ACUTE. 

The treatment of acute nephritis, accompanied by any active 
inflammatory change, requires care and intelligence. The pain in 
the loins and, perhaps, the bloody urine, which is scanty and high 
colored, the febrile disturbance, and the history of exposure or other 
exciting cause, all form a clinical history typical of its major points. 
Here, as elsewhere, for the reduction of inflammation, circulatory 
depressants are to be resorted to, and aconite is generally most service- 
able. The patient should be kept quietly in bed and supplied with 
a milk diet, cups or leeches being used over the loins if the urine is 
scauty. Blisters are not advisable, as the irritant substances pro- 
ducing them may be absorbed and cause increased renal irritation. 
The restlessness will generally be quieted by the aconite, but if 
this fails, resort must be had to bromides, or small doses of opium, 
which must be given cautiously, as it is not readily eliminated 
when the kidneys are diseased. Cannabis inclica is thought to be of 



bright's disease, chronic. 363 

great service if bloody urine is present, but chloral is generally too 
irritating to the kidney to justify its employment. The appearance of 
large amounts of blood in the urine is an indication for the use of 
drop doses of tincture of cantharides, according to Sidney Ringer, 
given every few hours at about the fifth day. 

If dropsy comes on and is excessive it must be relieved by the use 
of hydragogue purges, such as elaterium, which is particularly useful 
in that it is supposed to aid in the elimination of the urea by the 
bowel. Jaborandi or pilocarpine may be used to sweat the patient at 
this time or in the earlier stages with advantage ; J grain of the mu- 
riate should be given hypodermically and repeated in fifteen minutes 
if no sweat appears. Hot-air baths are often useful to provoke a 
sweat. Warm mucilaginous drinks, as flaxseed tea, are of service, and 
the use of the citrate of potassium and sweet spirits of nitre should be 
resorted to to increase urinary flow. Generally these cases go on to 
recovery, which is, however, often somewhat prolonged. The treat- 
ment of the later stages consists in the use of stimulants to the kid- 
neys to arouse them from the atony consequent upon the excitement 
of inflammation. To this end digitalis and squill, or digitalis and 
calomel may be used in small amounts gradually increased and fol- 
lowed by the compound spirit of juniper or gin as the case progresses. 
If the renal structure is persistently atonic, J to 1 drop of the tinc- 
ture of cantharides at each dose may be used, and as anaemia is often 
a prominent symptom, tincture of the chloride of iron, which is both 
diuretic and a tonic, should be resorted to. If renal hemorrhage is 
excessive, gallic acid and ergot are indicated to control the bleeding. 



BRIGHT'S DISEASE, CHRONIC. 

The treatment of chronic nephritis is a very different matter, so 
far as prognosis is concerned, from that of the acute form. It is 
almost, if not quite, impossible to cure the condition present and 
we can only improve the state of these and other organs by care and 
proper drugs. As Tyson has aptly put it, we must try to arrest the 
development of the renal lesions and improve the general health, 
treat the symptoms which are not dependent upon the nephritis, 
except indirectly, and last, treat those signs which are due to the 
nephritis itself. To arrest the disease all alcoholic drinks should be 
avoided as far as possible and business cares and worries be cast 
aside. Great care should be taken to avoid cold and a warm climate 
is generally to be recommended. 

The diet and drink are important considerations and should con- 
sist largely of milk. Beyond this we can do little toward a cure. 
To allay symptoms Ave can do much, and the albuminuria can be 
greatly decreased by the use of digitalis, squill, the acetate and bitar- 
trate of potassium, and the iodides ; nor should the bichloride of mer- 



364 DISEASES. 

cuiy be forgotten. These remedies are also of value to relieve the 
dropsy, and the most efficacious of them all is probably a combination 
of the bi tart-rate of potassium and juniper berries, so that 1 ounce of 
the former is dissolved in 1 pint of an infusion of the latter and taken 
in twenty-four hours. If dropsy ensues hydragogue purges are use- 
ful, such as jalap and elateriurn, and hot baths, Turkish or Russian, 
are to be given, not only to relieve the dropsy, but so to hypertrophy 
the excretory glands of the skin that they will relieve the kidneys. 

The ascites or thoracic effusions, which occur, should be tapped 
and drawn off. 

In the interstitial forms of the disease Bartholow has highly rec- 
ommended the use of the chloride of gold and sodium in the dose of 
TTo *° To g ram - The anaemia is to be combated by the use of the 
tincture of the chloride of iron and oxygen inhalations. 

The arsenite of sodium and the carbonate or citrate of lithium are 
also said to be of value in this form of Bright' s disease, particularly 
if it is dependent upon a gouty taint. The dose of the former should 
be t^j- grain, and of the latter 5 grains three times a day. 



BRONCHITIS, ACUTE. 

In the early stages of bronchitis there is always present a very 
distinct hyperemia, followed by a true inflammation of the mucous 
membrane lining of the bronchial tubes. When these changes are 
confined to the larger bronchi the term bronchitis is employed, but 
when the minute bronchioles are invaded the disease is known as 
capillary bronchitis. Under the head of " pueumouia " and else- 
where, the writer has spoken of the various stages of inflammations, 
and has described the action of the various drugs and measures here 
indicated. In many cases the physician only sees the patient when the 
second stage of his disease is present, but if the individual presents 
himself at once the following history and physical signs will indicate 
the treatment to be employed. After exposure, more or less severe, to 
wet, dampness, or dry cold, a sensation of oppression comes on, asso- 
ciated with a feeling of " tightness across the chest," or a sensation as 
if a lump of food was under the sternum. Aching and pain may then 
be traced over the lines of the bronchial tubes, while the dry hacking 
cough increases the discomfort and seems to strain the tubes till each 
one can be outlined on the chest wall by the patient. The cough, 
when it occurs, is virtually unproductive, and often hurts the larynx 
and throat. On making a physical examination by auscultation 
there will be found over the posterior aspect of the chest, between 
the shoulder-blades, increased sounds of bronchial breathing, which 
is rougher than normal, due to the air passing over an inflamed, 
swollen, and roughened mucous membrane. This bronchial rough- 



BRONCHITIS, ACUTE. 365 

ening may be sufficient to cause a harsh respiratory sound over the 
entire chest, and expiration may be heard a little louder than usual. 
No other changes from the normal can be noted, but isolated spots of 
discomfort maybe pointed out by the patient where aches, "catches," 
or " kinks " seem to be present in a previously normal tube. Per- 
cussion, palpation, and inspection show nothing more of note. 

If possible the patient is to be put to bed and ordered, if he be 
strong and hearty, and if the signs of inflammation are severe enough 
to cause alarm, a free dose of pilocarpine for the production of a 
sweat, particularly if there is a great necessity for rapid cure without 
regard to the nausea which may be produced by the drug. If this 
is done no other medicine need be used, but the employment of a 
mustard foot-bath and a drink of hot brandy or whiskey and water 
should be ordered. 

If, for any reason, this treatment is not called for, and in many 
cases it will be found unnecessarily severe, the pilocarpine may be re- 
placed by full doses of 2 to 3 drops of the tincture of veratrum 
viride or a teaspoonful of the wine of antimony in adults, or \ to 1 
drop of the tincture of aconite in children, the employment of hot 
drinks and a foot-bath being also insisted upon. 

The use of antimony as a remedy in the early stages of bronchitis 
should only be resorted to when a very powerful action is required 
and the individual very strong and sthenic. Under these circum- 
stances it may be given in full enough dose to produce marked 
nausea and even vomiting with a profuse sweat. Along with the 
depression a profuse outpouring of liquid takes place in the bronchial 
tubes, which speedily relieves their congestion, and in consequence 
brings on the second stage of the disease in an hour or two instead 
of in two or three days. Unless some pressing need requires it, most 
persons will regard this remedy as worse than the disease. 

Counter-irritation may be applied to the chest in the shape of a 
mustard or spice plaster, or dry cups may be employed, several on 
each side of the vertebral column, at about the sixth rib. If the sore- 
ness of the bronchial tubes is not relieved by this means, inhalations 
of steam arising from boiling water placed before the patient may be 
practised, either by means of a cone covering the top of a pitcher and 
the mouth and nose of the patient, or by covering the head and pitcher 
with a towel. The usefulness of this method may be much increased 
by the introduction of one tablespoonful of compound tincture of 
benzoin to each pint of water. In children, both in this first stage 
of bronchitis and in the later stages, the use of the so-called " bron- 
chitis tent " is of great value. It consists of a canopy raised over the 
bed, a sufficient distance to allow of plenty of air, through one side of 
which passes a tube leading from a tin pail or kettle of boiling water, 
under which is an alcohol lamp to keep the temperature of the water 
sufficiently high. By this means the air breathed by the child is so 
saturated with moisture that the mucous membrane lining the air- 



366 DISEASES. 

passages is soothed and quieted. In order that the full benefit of this 
measure be understood, it must be remembered that a mucous mem- 
brane in the early stages of inflammation is always dry and red, lacking 
its normal moisture, and that the upper air-passages fail to catch upon 
their surfaces, by reason of their dryness, particles of dust, and do 
not moisten the air before it reaches the lungs. Again, it will be 
remembered that the bronchial mucous membrane is covered with 
ciliated epithelium which, by its constant upward wavy motion, urges 
out of the lung all impurities. Dryness of the surface at once stops 
this ciliated movement with unfavorable results. The employment 
of the " bronchitis tent " is equally useful in adults, but less readily 
employed owing to the size of the bed. Poultices may be used, and 
while the cardiac sedatives are acting, resort should be had to ipecac 
and citrate or acetate of potassium, which act as sedatives to the in- 
flamed mucous membranes and aid in the formation of secretion, 
moistening the surfaces and thereby overcoming the dryness and irri- 
tation. The potassium salts also act as a febrifuge and should be 
used in full doses, as much as 40 grains to a drachm in a day. The 
following prescription illustrates their employment : 

& .—Syr. ipecac fgj. 

Potas. citrat . giv. 

Aq. destillat q. s. f^-vj. 

M. — S. Dessertspoonful every four hours for a child of five years. 

Or— 



}£. — Syr. ipecac. 

• Succus limonis . , 
Potas. carbonat. 
Spirit, aether, nitrosi 
Aq. dest 

M. — S. Dessertspoonful every four hours for an adult. 



^iv. 
q. s. f^vj. 



For a child this prescription should be reduced just one-half in 
each part. 

When fever is persistent, quinine should be used, and if the cough 
be excessive and annoying -j^ to -^ grain of morphine may be given 
in each dose of the solution just given, or a few drops of the spirit 
of chloroform may be added to the prescription. 

Having considered the treatment of the first stage of bronchitis, 
we pass to that of the second. The condition of the mucous mem- 
branes is now quite different from that which we have just been 
speaking of. In the place of an absolute lack of secretion we have 
a profusion of cast-off epithelial cells, a large amount of mucus, and 
more or less liquid poured out upon the walls of the bronchial tubes 
forming obstructions everywhere to the ready passage of air. The 
secretion is apt to be more or less viscid, ropy, and in lumps when 
it is coughed up after considerable effort. This state is one in which 
the excitement of inflammation is followed by local depression and 



BRONCHITIS, ACUTE. 367 

an effort on the part of the tissues to rid themselves of some of the 
congestion and useless epithelial formations. The physical signs on 
listening to the chest are now found to consist in a large number of 
fine rales which are distinctly wet and moist. Later they become 
markedly liquid and bubbling, and so large as to cause gurgling on 
inspiration and expiration. Sometimes they are musical or squeak- 
ing. Generally the latter signs do not come on until the case is far 
advanced, and, if a cure is soon to be reached, they only last a few 
days or hours, as the mucus is so loose as to be readily coughed up 
and the lung cleared. 

The object of the physician is to use remedies which will, as they 
are eliminated by the parts, stimulate the bronchial tubes and increase 
the volume of liquid poured out. For this purpose the bronchitis 
tent may of course be employed, but the drugs to be used internally 
are ammonia, chiefly the chloride, and the pitches and turpentines, 
such as terebene, pyridine 1 or even turpentine itself. Allium or 
garlic is often of great service at this time or a little later in the 
course of the ailment. It may be used by boiling garlic in milk, or 
by the application of an onion or garlic poultice. 

In the majority of instances an ammonia mixture will be the best 
and most serviceable prescription in one of the following forms : 

R. — Ammon. chlor gij. 

Ext. glycyrrhiz. . . . . . gij. 

Aq. destillat q. s. f^iij. 

M. — S. Teaspoonful every four hours. 

Or, 

R. — Ammon. chlor. . . ... . . spj. 

Mist, glycyrrhiz. comp. *^iij- 

M. — S. The same dose. 

The disadvantage of the latter prescription is the presence of anti- 
mony in the compound liquorice mixture. If the cough is trouble- 
some a little morphine or belladonna may be added, or the following 
be used, particularly if any signs of cardiac failure appear : 

R. — Ammon. chlor :^j. 

Ammon. carbon gj. 

Ammon. brom. . . . . . . . gj. 

Ext. glycyrrhiz. . . . . . . . giv. 

Aq. dest. . . f ^ vj. 

M. — S. Dessertspoonful every four hours. 

In this prescription the first constitutent acts particularly on the 
air-passages, the second stimulates the heart and respiration, and the 
third also allays the cough, the liquorice covering the salty taste of 
the ammonias. Ammonium chloride may be also used in the lung 
by the steam atomizer or by inhalation of the fumes by means of 

1 Pyridine, not pyrodine, is used by placing 1 fluidrachm on a hot shovel or sauce- 
pan in a small room., the patient breathing the fumes. 



368 DISEASES. 

some of the apparatus used for this purpose, and counter-irritation 
may do good at this stage, particularly over some aching bronchus, 
when a blister or plaster may be employed, or even a dry cup resorted 
to. If the administration of the chloride does not aid in the expulsion 
and liquefaction of the secretion, and rid the lungs rapidly of the 
mucus, the use of terebene in 5 or 10 minim capsules may be resorted 
to with great success. If capsules cannot be supplied terebene may be 
made into an emulsion with accacia or tragacanth and given in this 
way. Sometimes terebene will irritate the kidneys and produce a sense 
of weight across the loins, and if this occurs its use should be stopped. 
In other cases it will disorder the stomach or cause diarrhoea. These 
effects are not, however, commonly seen. Certain of the volatile oils 
and resins are also of value at this time, notably the oleo-resin of 
cubebs and copaiba, which, however, possesses the disadvantage of 
disordering the stomach. The oil of eucalyptus is also of great value 
and may be given in capsule or emulsion in the dose of from 1 to 5 
drops every five hours. The oil of sandalwood in the dose of 5 to 10 
minims is very valuable and not so apt to disorder the stomach, 
bowels, and kidneys as are some of the other remedies named. The 
balsam of Peru and Tolu may be used, but ought always to be com- 
bined with other more active drugs. Apomorphia has been highly 
recommended in the subacute stage of bronchitis as an expectorant 
for the purpose of loosening the phlegm and increasing secretion. 
The dose should be from -^ to ^ grain by the mouth, to an adult, 
three times a day, under such circumstances. Squill has had a 
very good reputation in this stage of bronchitis, but is a very poor 
remedy as compared to most of those now in use, irritating the stomach 
and kidneys and acting comparatively slightly on the diseased area. 

While the proper use of these remedies usually brings about 
the results desired, in others a stage of profuse secretion comes on, 
which in its treatment is identical with that seen in chronic bronchitis, 
chronic " winter cough," and emphysema, and they will, therefore, 
be considered together. 

In old persons suffering from dilated bronchial tubes, from 
emphysema, and from chronic bronchitis there is constantly poured 
into the air-passages so free a secretion that constant coughing is 
necessary to rid the lung of enough of the mucus and liquid to enable 
the man to breathe. Any excess of this exudation drowns him in 
his own secretions and the constant obstruction of the lung soon pro- 
duces dilatation and weakness of the right side of the heart. This 
same condition in a more acute form sometimes asserts itself in young 
children and in adults. In children it sometimes comes on so suddenly 
as to be known as " acute suffocative catarrh, " while in older persons 
it appears with sufficient severity to make the condition of the patient 
most serious. Of the treatment of this state the writer shall speak at 
once. The objects must be to rid the lung of the liquid secretions, to 
prevent the outpouring of more exudations and to support the patient 



BKONCHITIS, ACUTE. 369 

through the crisis. Where the exudations rapidly fill the lung 
nothing is better in the child or strong adult than an active emetic, 
such as apomorphine, hypodermically, in the dose of ^ grain to an 
adult, or ^V to a child, and repeated ; if this first dose fails to act in 
ten minutes, ipecac may be used instead in the form of the powder, 
a small teaspoonful for a man or 5 to 10 grains for a child, or if the 
powder be not at hand a tablespoonful of the wine or syrup of ipecac 
to an adult or two teaspoonfuls to a child may be given. Digitalis 
should be administered to support the heart, and strychnine be em- 
ployed in full dose to stimulate the respiratory centre and excite the 
nervous system, which is generally depressed by the increasing car- 
bonic acid in the blood. For the same purpose caffeine or strong 
coffee may be used. Oxygen may be inhaled and astringent sprays 
drawn into the air-passages, containing tannic acid, MonsePs solution, 
or other astringents such as shall be mentioned in a moment. If 
death seems at hand, hot and cold dashes of water may revive the 
patient sufficiently to keep up respiratory movements until voluntary 
efforts are made once more by the patient. 

The treatment of the more moderate condition of excessive secre- 
tion after bronchitis in old persons, which is more slow in its pro- 
gress, but which may end as fatally as similar attacks in the young, 
is somewhat similar to that just given. Injurious results are often 
produced by the physician failing to recognize that the secretion is 
sufficiently liquid, and that ammonium and such expectorants are not 
only useless, but harmful, because they increase the quantity of these 
liquids. Under these circumstances a fine spray of a solution of 
tannic acid of the strength of from 2 to 30 grains to the ounce may 
be used, or of alum solution from a few grains to saturation. Mon- 
sel's solution should be employed in the dose of 10 to 15 drops to 
the ounce of water, or acetate of lead may be used in the strength of 
from 1 to 15 grains to the ounce. Lobelia induces a too free secre- 
tion, and is contra-indicated under such circumstances. The use of 
opium to check the excessive excretion is a measure of doubtful value, 
as it checks the cough and causes the lung to become more rapidly 
filled with mucus. Belladonna, which checks secretion even more 
than opium, stimulates the respiratory centre, and is for this reason 
a doubly useful remedy. Counter-irritation may do good, and if the 
patient be strong free purgation should be resorted to. 

In those cases where dilatation of the tubes is present in old per- 
sons, calabar bean, in the form of the tincture or extract of physos- 
tigma, is of service, owing to its action, as a tonic, on the muscular 
fibres of the walls of the tubes preventing further bronchial dilatation 
and aiding in the expulsion of the secretion as rapidly as it is formed. 

The use of remedies designed to allay the cough in these cases is 
absolutely unjustifiable. The question as to whether the cough is 
excessive or not must depend on the ability of the lung to rid itself 
of the secretions in its bronchial tubes. 

24 



370 DISEASES. 



BURNS AND SCALDS. 

The treatment of burns and scalds is both internal and external, 
the first being devoted to the quieting of the nervous system after 
the shock, the relief of pain and the treatment of the shock while 
present, and the second to the care of the injured surfaces. Imme- 
diately upon being called to a case of burn, it is the duty of the 
physician to determine how badly shocked the patient is, what the 
condition of the pulse may be, and whether or not the lungs and 
air-passages are involved. After these mental notes, he should 
give a hypodermic injection of J to J grain of morphine and -^ of 
atropine, and then roll the entire body in a large quilt to maintain 
the bodily heat while the sufferer is being transferred to the hospital, 
or the house to which he belongs. 

In some cases the shock is so great that the pulse flags at once, the 
temperature fails, and collapse ensues. Stimulants hypodermically, 
external heat, and warm drinks of water and whiskey are indicated, 
followed by digitalis if the circulation does not respond to the less 
powerful stimulants. 

If time and circumstances permit, the dressings should be applied 
before moving the patient, but this is rarely possible. By far the 
best dressing is lint, wrung out of a mixture of linseed oil and lime 
water, equal parts, or, if desired, the oil may be rendered antiseptic 
by the addition thereto of 1 part to 20 of carbolic acid, which is also 
of service in that it acts as a feeble local anaesthetic. These cloths 
should be renewed every twelve or twenty-four hours, as may be 
needed, or they may be substituted by lint wrung out of a saturated 
watery solution of boracic acid. 

If the burn is not very diffuse a solution of the tincture of can- 
tharides, 1 part to 40, upon a rag, is said to relieve pain and aid in 
healing, but if the burned surface be extensive this treatment cannot 
be resorted to, owing to the irritation of the kidneys, which are al- 
ready overtaxed by the interference with the function of the skin. 
In comparatively small burns a saturated solution of carbonate of 
sodium (washing soda) often does great good in relieving the pain. 
This action may depend on the solvent power of this salt over albu- 
minous deposits, formed by the heat, which irritate the peripheral 
nerves. 

A large number of other remedies have been and can be used, but 
are no better than those named, and less generally employed. 

A very important point in the subsequent treatment of bums is 
the remembrance of the close relationship existing between the in- 
ternal organs, particularly the kidneys, and the cuticle. When we 
recollect that we try to influence internal congestions, such as pul- 
monary congestion for example, by the application of irritation to the 



CHANCROID. 371 

skin of the chest, we see at once that a widespread and severe burn 
is a huge counter-irritant and must affect the viscera. 

Again, the skin being prevented from exhaling impurities, forces 
the kidneys to do the work, and, if the kidneys fail under the strain, 
death results. Whenever the urine is high colored and cloudy the 
citrate of potassium should be freely given, 20 grains in water three 
times a day, combined with 30 drops of sweet spirits of nitre. 



CHANCROID. 

The chancroid is a contagious non-specific ulcer, w 7 hich has no 
period of incubation, is distinctly inflammatory in type, and is usually 
multiple. It is further distinguished from the primary sore of 
syphilis by the fact that it is auto-inoculable, is not followed by 
secondary eruptions, and, if it involves the lymphatics at all, produces 
a monoganglionic unilateral swelling which frequently attains a con- 
siderable size, and suppurates. 

Chancroid being a purely local affection, would seem to require 
nothing beyond local treatment ; this is true of the uncomplicated 
sore, but, where phagadena or serpiginous ulceration sets in, the ques- 
tion of constitutional treatment is of paramount importance. 

The treatment of uncomplicated chancroid is as simple as it is 
efficient. One thorough cauterization converts the sore into a healthy 
ulcer, the cicatrization of which is quickly and surely accomplished. 

As the most efficient means of thoroughly destroying the chan- 
croidal ulcerations, the actual cautery is chiefly commended. This 
is, however, objectionable to patients. Sulphuric or nitric acid will 
be found equally serviceable. The pain of its application may be 
greatly lessened by the previous employment of a 20 per cent, solution 
of cocaine. When the surface involved is large the patient should 
be etherized. The cardinal part in the cauterization of chancroids is 
to reach and destroy all the diseased area. Every pocket and sinus 
must be thoroughly acted upon, otherwise it remains as a focus for 
reinfection. A convenient way of both destroying the chancroid and 
providing for the after-dressing is offered in the application of Eicord's 
paste. This is made by adding to finely powdered charcoal enough 
strong sulphuric acid to form a paste of about the consistency of 
castor oil. This is then applied to every portion of the ulcer. The 
acid shortly dries out, leaving a dressing of charcoal which in a few 
days drops off, exposing a healthy, nearly healed, granulating surface. 
Where nitric acid is applied the subsequent dressing consists, prefer- 
ably, in the application of dusting powders, iodoform being the best. 

There has been a tendency of late years to substitute for this treat- 
ment one less radical, more acceptable to the patient, and in many 
cases almost equally satisfactory in results. It is certainly true that 



372 DISEASES. 

many of the chancroids as found in persons of robust health show 
little tendency to spread beyond comparatively narrow limits, and are 
amenable to mild treatment. It must be remembered, however, that, 
as long as the smallest portion of such an ulcer remains uuhealed, it 
may, at any time, take on all the features of a virulent ulceration. 
Moreover, the patient is constantly exposed to the risks of a chan- 
croidal bubo, a complication so troublesome that the possibility of its 
development constitutes the strongest argument against palliative 
treatment. 

Where the ulceration is entirely superficial, constituting the erosive 
form of chancroid, iodoform, dusted over the surface of the carefully 
cleansed granulations, offers the best form of palliative treatment. 
As a cleansing and stimulating wash, to precede the application of 
the iodoform, nitric acid 5j to water Oj is most satisfactory. The 
objection to iodoform lies in its disagreeable and penetrating odor. 
To prevent this great care should be exercised in applying the pow- 
der to see that none is distributed elsewhere than upon the sore. 
The odor can also be disguised to an extent by thoroughlv mixing 
with the iodoform a small quantity of one of the essential oils, such 
as oil of peppermint or attar of roses, using not over tr^y to 5j of 
the powder. There is no dusting powder which can entirely take 
the place of iodoform, yet when the objections to the use of the latter 
are insuperable iodol may be substituted, or a mixture of zinc oxide 
5j and bis. subnit. 5iij, or equal parts of calomel and bismuth. Where 
the discharge is profuse, powdered tannin may be combined with the 
dusting powder in the proportion of one part to four. 

In the ordinary uncomplicated chancroid these dry dressings are 
greatly to be preferred to wet applications; when, however, the sore 
is attacked by a high grade of inflammation, and becomes indurated, 
prolonged immersion of the part involved, or of the whole body, in 
hot water may be followed by the application of dressings kept con- 
stantly wet with the dilute nitric-acid lotion, as given above, or with 
weak carbolic solution, 5 grains to the ounce of water, or with lead 
water and laudanum. Where the chancroid assumes the phagadamic 
type, extending with great rapidity and causing extensive sloughing 
and destruction of tissue, free cauterization, either with the hot iron 
or by means of nitric acid, should be instituted immediately, every 
portion of the ulcerating surface being thoroughly destroyed. This 
should be followed by prolonged hot sitz-baths or general warm 
baths, the patient remaining in the water for days at a time, if nec- 
essary, and, if practicable, eating and sleeping with the body still 
immersed. If this is not possible, baths of from two to four hours' 
duration should be given two or three times daily. After cauteriza- 
tion, powdered iodoform is the best local application in phagadamic 
cases. In addition the patient may be given full doses of opium, and 
should receive a tonic and supporting treatment. 

Should the chancroid assume the serpiginous type, slowly extend- 



CHOLERA, ASIATIC. 373 

ing in spite of treatment, till, in the course of months or years, large 
areas are destroyed by the process, the warm bath continued night 
and day for weeks at a time, together with thorough cauterization of 
the entire diseased surface with the hot iron, represent the most satis- 
factory methods of treatment. 

The chancroidal bubo is best avoided by prompt and thorough 
cauterization of the sore ; when it occurs, however, it should be first 
treated by rest, pressure, and counter-irritation, since it may be a 
simple inflammatory adenitis, and, with care, may not run on to 
suppuration. Iodine may be painted around the swollen area, the 
patient should be put to bed, and a compress, together with a spica 
bandage of the groin, should be applied, or this may be substituted 
by a wet bag placed upon the inflamed gland. At the first sign of 
suppuration the bubo should be opened freely, should be washed out 
with bichloride solution, 1 to 1000, peroxide of hydrogen, half 
strength, or chloride of zinc, grains 40 ad. 5j aq., and should be 
packed with iodoform gauze. If the bubo takes on phagadamic action 
it should be treated precisely as the phagadamic chancroid. 



CHOLERA, ASIATIC. 

The treatment of this exceedingly dangerous disease is prophy- 
lactic, curative, and convalescent. 

The first measures consist of strict quarantine, both public and 
private, the avoidance of all water for ordinary purposes which has 
not been boiled at least an hour, and cooled in a place devoid of 
germs, and the employment of those foods w T hich, while preserving 
the normal bodily health, in no way predispose to intestinal dis- 
turbances, as do some of the fruits, as melons and grapes. If these 
things are attended to, little remains to be done ; but it is worthy of 
remark that sulphuric acid, perhaps by its anti-diarrhoeic influence, 
is a drug which is harmless in itself, yet apparently one which is 
possessed of distinct prophylactic power in this disease. 

The treatment of the attack itself is supportive, and directed to 
the curtailment and modification of the symptoms shown. Above 
all things the diarrhoea must be controlled, if this is possible, since 
it saps the strength and induces the collapse which ends in death. 
To this end 10 drops of aromatic sulphuric acid may be given every 
two hours and may be accompanied by 5 or 10 drops of the strong 
spirit of camphor and 20 drops of laudauurn until constitutional 
symptoms prohibit the further use of the opiate. If the vomiting 
is too severe to permit of the use of the laudanum by the mouth, 
morphine should be given hypodermically, and it is to be remem- 
bered that this treatment may be resorted to even in the stage of 
collapse. Sometimes the spirit of chloroform in 5 to 10 drop doses 



374 DISEASES. 

every hour is of great service. The remembrance that the purging 
must be constantly decreasing the liquids in the tissues, thereby 
altering the constituency of the blood, renders it evident that some 
means must be taken to replace the salts and water lost. For this 
purpose large draughts of water are to be employed, and, if possible, 
the following salts should be placed in it, the proportions being 100 
parts of a saturated solution of tribasic phosphate of lime and 5 
parts of a one per cent, solution of potassium chloride. This fluid 
,is very nearly identical with the blood physiologically, and may also 
be used intravenously with great success in place of defibrinated 
blood, to which it should always be preferred. No food must be 
given by the mouth during an attack if it can be avoided, but nour- 
ishment is to be obtained chiefly by way of the rectum, using pre- 
digested milk or beef-broth. Friction of the arms and legs as well as 
of the trunk is often a comfort, and the use of hot broths tends to put 
off the algid stage. To control the vomiting small doses of cocaine 
may be employed and a turpentine stupe applied to the belly. 

Very recently Harkin has written in high praise of the so-called 
" vagus treatment" of cholera and has recorded cases in his own and 
others' practice which reached brilliant cures by the use of a fly- 
blister over the course of the vagus nerve on both sides of the neck, 
just beneath the angle of the lower jaw. The explanation of this 
treatment rests in the belief that cholera is dependent upon some 
impairment of the functions of this nerve in the abdomen. 



CHOLERA INFANTUM. 

Cholera infantum is a term often applied to all the forms of active 
serous diarrhoea afflicting children in the summer months, whether 
its cause be exposure to high heat or bad food or both. In reality the 
term should be applied to that form of serous diarrhoea in which heat 
is the most common cause, and in which symptoms of lowered vitality 
and collapse rapidly come on with coldness of the extremities, pinched 
face, and wrinkled skin. The treatment by drugs is identical in all 
forms of serous diarrhoea in children so far as the purging is con- 
cerned, but the removal of the cause requires greater care in its 
discovery and more skill in its cure. 

In cities, particularly where the heat is often great, the air damp 
and impure, and the food not always fresh, cholera infantum often 
appears as a form of thermic fever or heat exhaustion, or, in other 
words, as sunstroke. In these cases the temperature in the rectum 
will be found febrile, while that of the axilla is below normal, and 
as pyrexia does harm to the internal organs the internal temperature 
must be lowered by cool drinks, pieces of ice, and the careful use of 
antipyretics. The diarrhoea in this case is dependent upon a relaxa- 



CHOLERA INFANTUM. 375 

tion of the bloodvessel walls in the intestine by reason of the influ- 
ence of high heat over the splanchnic nerves, and may also be partly 
due to irritant matters derived from food, and resulting from poor 
secretion of the digestive juices. If the thermometer placed high up in 
the rectum shows a subnormal temperature, heat exhaustion is present, 
not thermic fever, and the treatment is reversed : Hot drinks are to 
be used, external heat applied, and friction of the limbs resorted 
to, or the child may be put in a hot bath at a temperature of 105° 
F., its temperature being carefully watched lest it rise suddenly to 
above the normal. Vomiting is nearly always a prominent symp- 
tom in cases of cholera infantum, and it is best under any circum- 
stances to use predigested milk in teaspoonful doses every fifteen or 
twenty minutes. If vomiting is active and collapse is threatened, a 
few drops of good brandy should be used in each teaspoonful of 
nourishment. 

There is another form of cholera infantum which is not due to a 
high atmospheric temperature alone, but more commonly to the inges- 
tion of irritant foods or foods unsuited to a child, obtained surrepti- 
tiously or through the ignorance of the parents. If there is such a 
history, and none of the masses of undigested food have been passed, 
a purgative dose of castor-oil (1 to 2 teaspoonfuls to a child of two 
years) with 20 drops of paregoric should be used to sweep out the 
offending materials and allay irritation, and be followed at once by 
the treatment which will be spoken of in a moment. Care, of course, 
should be taken to maintain the bodily heat or lower it if it is above 
the normal, and a watch must be kept upon the pulse and breathing 
to note any changes requiring stimulants. 

The diarrhoea must be stopped at once to save the tissues, while 
the medicinal treatment should consist in the use of a mixture such 
as the following, for a child of a year or eighteen months. 

R. — Acid, sulph. aromat.. ..... gtt. xxiv. 

Tr. opii camphorat. . . . . . fgiij. 

Elixir curacose . . . . . . f gij. 

Aqua cinnamomi . . . . q. s. fgiij. 

M. — S. Teaspoonful every two hours. 



Or 



R. — Acid, sulph. aromat. 
01. caryophylli 
Tr. opii camphorat. 
Spirit, chloroformi. 
Syr. zingiberis 
M. — S. As above. 



. gtt. xxiv. 

. TTlviij. 

• f 3J- , ... 

. gtt. xlvnj. 

q. s. fgiij. 



If preferred, the tincture of kino, or compound tincture of catechu, 
may be substituted for the oil of cloves or the spirit of chloroform, 
and again the extract of hsematoxylon may be taken in the place of 
either of these. Where the vomiting is very severe and incessant, the 
purging profuse, ill-smelling and mouse-like in odor, a rectal injection 



376 . DISEASES. 

of starch- water, 3 ounces, containing 10 drops of laudanum, is to be 
employed, and at the same time J of a grain of gray powder (hydrar- 
gyri cum creta) given every hour. The gray powder may be sub- 
stituted by y 1 ^ of a grain doses of calomel. Very minute doses of 
arsenic given by means of the following solution are often of service 
in checking the vomiting and purging, and should be resorted to if 
necessary : 

R. — Liq. potas. arsenitis gtt.jvel. ij. 

Aq. cinnamoni q. s. Sjj. 

M. — S. Teaspoonful every fifteen minutes till four teaspoonfuls are taken. 

In still other cases the remedies named above only stop the diar- 
rhoea for the time being, and it returns as soon as they are with- 
drawn. In such a case the following is of value to restore the lost 
tone of the parts involved : 

R . — Kesinse podophyllin gr. J. 

Liq. potas. arsenit. ..... gtt. iij.vel vj. 

Liquor calcis . . . . . q. s. f^iij. 

M. — S. Teaspoonful every 5 hours, or a powder may be used. 

R. — Kesinse podophylli . . . . . gr. J. 

Pulv. ipecac. gr. j. 

Sac. lact. ....... gr. xx. 

M. ft. in chart., No. x. — S. One powder every five hours. 

A very important, never-to-be-forgotten measure in cholera in- 
fantum is the use of counter-irritation over the belly by means of a 
mustard plaster (1 part mustard flour to 4 of wheat flour) or a spice 
plaster. The plaster should be renewed as often as it cools, and 
kept on continuously if the skin will stand it. 



CHOLERA MORBUS. 

This acute, painful, rapidly exhausting disease arises from ex- 
posure to cold, the ingestion of poisonous or irritating foods, exposure 
to excessive heat, and to a number of similar causes. 

In reality it may be regarded in one instance as a gastro-enteritis, 
and in another as an acute serous diarrhoea associated with much 
pain of a griping, rending character. Nothing compares to counter- 
irritation for the purpose of affording relief. A large mustard or 
capsicum draft should be placed over the abdomen and allowed to 
remain as long as it can be borne. If the patient knows that he has 
taken irritant foods, castor-oil with laudanum added to it to prevent 
griping should be employed to sweep out the offending masses be- 
fore any other remedies are used, and be followed by a diarrhoea 
mixture such as here follows : 

Je. — Acid, sulph. arom. . . . . . fg ij. 

Ext. hsematoxylon . . . . % ij. 

Spt. chloroformi . . . . . . f % ss. 

Syr zingiberis . . . . . q. s. f ^ iij. 

M. — S. Teaspoonful every two hours. 



(See Anaemia.) 



CHOREA. 377 

CHLOROSIS. 
CHOREA. 



St. Vitus's Dance is a more or less obstinate nervous affection, 
generally occurring in children, yielding to treatment quite rapidly 
in some cases and in others remaining persistently severe, and even 
becoming worse under the physician's care. 

The disease is always to be treated by the removal of any sources 
of reflex irritation, such as worms, a long prepuce, or other trouble 
of this character, and in the avoidance of punishment or severe re- 
buke on the part of the attendants. Aside from that form of the 
disease closely associated or dependent upon rheumatism, the profes- 
sion universally employ arsenic in one of its preparations as a specific 
remedy. Generally Fowler's solution is used, and unless the parents 
are intelligent enough to drop medicine carefully from a bottle or 
dropper, the physician should order a three-ounce mixture, so that each 
teaspoonful will contain two drops of the drug. Very frequently, to 
be effective, arsenic must be used in ascending doses, increased one 
drop a day, and, in consequence the dilution first spoken of, has to 
be avoided and the importance of care in measurement urged upon 
the patient's relatives. 

Whenever arsenic is used the physician should instruct the attend- 
ants to stop administering the drug if any puffiness under the eyes 
is seen in the morning on arising from bed, or if any pain in the 
bowels ensues, as these signs show that the full medicinal action of 
the drug is being felt. Where arsenic fails, cimicifuga in the dose of 
20 to 30 drops of the fresh fluid extract to a child of ten years may 
be used as the next best remedy. 

Where the disease is associated with rheumatism, near or remote, 
the salicylates or iodides may be of value, and should be thoroughly 
tried. 

In some cases of chorea the muscular jerkings are so severe that 
sleep is impossible aud the patient has to be held in bed and the bed- 
covers tied down. These cases will often obtain a quiet night by the 
use of the hot pack at bed-time. The child should be placed in a 
blanket previously dipped in as hot water as can be borne by the 
patient and thoroughly wrapped up in another dry blanket, to retain 
the heat, and allowed to sweat. Care must be taken that a heat- 
stroke does not result, and, if sweating does not come on and and op- 
pression ensues the blanket must be removed. The sheets should 
be ironed to have them warm for the patient when he is returned to 
bed, and it is often better to let him sleep between dry blankets. 



378 DISEASES. 

The efficacy of this treatment is largely increased by the use of a dose 
of bromide of sodium or potassium and a little chloral, as follows : 

R.— Chloral #j. 

Sodii. bromid. . . . . . . ^ss. 

A q- ■ q- s. t^iij. 

M. — S. Teaspoonful in water every five hours for three doses. 

The nitrate and oxide of silver have been largely used, but are not 
reliable remedies in this disease. The dose of the first should be J to 
J grain, and of the second J to J grain in pill form. 



COLIC, HEPATIC. 

This exceedingly painful condition, due to the passage of a gall- 
stone through the bile-ducts, is always associated with faintness, 
nausea, and great agony. 

The object of the physician must be to relieve this pain, not only 
by the use of anodynes, but also by aiding in the escape of the stone 
into the bowel. To relieve the pain a hypodermic injection of mor- 
phine \ to J grain accompanied by ^ grain of atropine is indicated. 
The opium not only decreases the pain but allays spasm, and the 
belladonna relaxes the spasm of the muscular coats of the ducts and 
allows the stone to pass through the relaxed passage-way. Hot ap- 
plications, such as a turpentine stupe, may be used over the liver but 
relaxation is not to be obtained by the use of nauseating emetics, as 
the retching may rupture the distended gall-bladder. Severe rub- 
bing should not be used for the same reason. 

Very recently the use of olive or cotton-seed oil has come largely 
into use in this affection, and while we are not sure of the means by 
which it acts, the studies of Rosenberg and others point to the chang- 
ing of the oil into glycerin and fatty acids, the first of which lique- 
fies and increases the flow of bile. The oil is used during the attack 
of pain, and must be swallowed in the dose of half a pint at least, 
smaller quantities do not suffice. Its action may be aided and its 
retention in the stomach promoted, by the addition of a drachm of 
ether to each dose. 

Shortly after the oil is swallowed, sudden relief often occurs, due 
to the escape of the stone into the bowel. The passage should then 
be carefully watched for gall-stones, but care should be taken that 
the lumps of soap which are passed, made from the oil by the alkaline 
juices in the intestines, are not mistaken for true biliary calculi. If 
the pain does not yield to morphine, chloroform or ether may be in- 
haled for the relaxation of the spasm and the relief of pain. 

The treatment of the state predisposing to the formation of hepatic 
calculi is largely that of a moderate, regular diet devoid of much fats, 
wines or beers, and in the following of an out-door life. 



CONJUNCTIVITIS. 379 



CONJUNCTIVITIS. 



Simple conjunctivitis requires the use of a boracic acid lotion (gr. 
10 to the ounce), and if there be much muco-purulent discharge ever- 
sion of the lids and the application of a 2 to 5 grain solution of 
nitrate of silver. During the subsidence of the inflammation, and if it 
shows any tendency to become chronic, sulphate of zinc (gr. 2 to 4 to 
the ounce), either with or without boracic acid, may be dropped into 
the eye, or sulphate of alum (gr. 4 to the ounce), or the local applica- 
tion of an alum stick. Much inflammatory reaction in this disease 
may be alleviated by cold compresses. These are rendered more 
efficacious if dipped in equal parts of water and the extract of hama- 
melis. 

Burns of the Conjunctiva. — Immediately after the accident all 
foreign particles should be removed or neutralized with a weak acid 
or alkaline solution if a liquid caustic or acid solution has entered 
the eye; then a few drops of cod-liver oil may be instilled and atro- 
pine employed (suitably incorporated with liquid vaseline) to prevent 
iritis. The chief danger lies in the formation of severe corneal in- 
flammation and symblepharon ; the latter may sometimes be pre- 
vented by daily breaking up the granulation tissue or by the insertion 
of a piece of gold-beater's skin between the inner surface of the lids 
and the eyeball. The associated conjunctivitis and keratitis require 
treatment differing in no way from that described in the idiopathic 
forms of these affections. 

Chronic conjunctivitis may result from an antecedent acute inflam- 
mation of the conjunctiva, or exist as an idiopathic affection, especi- 
ally in elderly people in whom it sometimes becomes a troublesome 
symptom, especially if complicating cataract. The characteristic 
lesions are roughness of the papillae of the conjunctiva, swelling of 
the caruncle, and soreness of the angles of the eyelids. There are 
no granulations, although the disease is sometimes inaccurately 
spoken of as granular lids. A soothing wash is indicated (10 grains 
of boracic acid to the ounce of water) to which may be added 2 
grains of cocaine, provided the cornea is not ulcerated, and for which 
a similar boracic acid lotion with 4 grains of salt to the ounce may 
be substituted. A very suitable local application is lapis divinus 
(sulphate of copper one part, alum one part, nitrate of potassium one 
part, fused together, and camphor equal to one-fiftieth of the whole 
added. The mass is run into sticks and the application made to the 
everted lids, or 1 grain of the same preparation to the ounce of water 
may be dropped into the eye). Other useful applications are tannin 
and glycerin (gr. 10 to the ounce), yellow oxide of mercury salve, 
and alum crystal. If refraction error exist this should be corrected. 
It is to be remembered that chronic conjunctivitis distinctly compli- 



380 DISEASES. 

cates any operative interference in the eye, as, for instance, cataract 
extraction. 

Chemosis of the conjunctiva, in which this membrane is infiltrated 
with serum, is usually a symptom of other ocular disorders, and sub- 
sides with the general treatment directed to their relief. Good results 
may follow nicking the swollen tissue with a pair of scissors; the 
application of a warm, moist compress, and the use of astringents, 
especially alum. 

Diphtheritic conjunctivitis is rare in this country, but on the con- 
tinent of Europe occasionally occurs as an epidemic. It may appear 
alone or in association with diphtheria of the throat and nose. The 
initial subjective symptoms are those of purulent ophthalmia ; the 
characteristic objective symptoms, a board-like infiltration of the lids 
with a deposit of gray membrane upon the palpebral conjunctiva. 
More than in any single eye disease destructive inflammation of the 
cornea is threatened. In the early stages the eye should be fre- 
quently cleansed with boric acid or bichloride of mercury solutions, 
and atropine instilled, while hot compresses help to make the nutrition 
of the cornea more perfect than the cold compresses which were for- 
merly recommended for antiphlogistic purposes. Tweedie has highly 
recommended a solution of quinine (gr. 3 to the ounce) ; Burgomaster 
insufflation of flowers of sulphur; w T hilein France the local application 
of lemon juice or citric acid ointment has been endorsed ; Galezowski 
uses oil of cade (1 to 10). In the early stages all caustics are contra- 
indicated ; after absorption of the membrane and reestablish ment of 
the discharge the cautious use of nitrate of silver in the manner de- 
scribed under purulent ophthalmia may be employed. The constitu- 
tional measures for diphtheria are necessary. 

Follicular conjunctivitis, a disease sometimes mistaken for granular 
lids, but having a distinct clinical difference, requires for its local 
treatment weak astringents and antiseptic lotions, and the applica- 
tion to the swollen follicles of an ointment of sulphate of copper (gr. 
J to the drachm), dusting in calomel either alone or with equal parts 
of subnitrate of bismuth, and iodoform used in the same way. 

This disease, or one analogous to it, is sometimes produced by the 
instillation of atropine. If this is its cause then the drug must be 
suspended and the surface painted with an alum crystal. 

Hemorrhage beneath the conjunctiva (subconjunctival ecchymosis) 
may follow an injury, occur during a paroxysm of whooping-cough, 
and occasionally, in elderly people, may appear spontaneously. No 
treatment materially hastens the absorption of the blood unless 
it be massage of the globe through the closed lid ; any associated 
conjunctival irritation may call for a boric acid and cocaine wash. 

Lachrymal conjunctivitis is a name given to a chronic form ot 
inflammation of the conjunctiva, associated with obstruction in the 
lachrymal duct, and characterized by a tear-soaked appearance of the 
eye, small pustules at the roots of the lashes, and a gummy discharge 



CONJUNCTIVITIS. 382 

along the palpebral margin. This can only be cured by relief of the 
stricture of the nasal duct which causes it, but may be alleviated with 
the same remedies recommended in the treatment of chronic con- 
junctivitis. 

Muco-purulent conjunctivitis. — This disease differs from the for- 
mer only in the presence of a greater amount of discharge. The 
same antiseptic lotions may be employed, to which may be added, 
with advantage, bichloride of mercury (grain 1 to the pint). Here,. 
nitrate of silver (grains 10 to the ounce), applied in the manner al- 
ready described, and with careful neutralization of the excess, with 
either a solution of salt or washing it away with tepid water, may be 
practised. Poultices or bandages should be applied. 

Purulent conjunctivitis, which is commonly seen in the adult in 
the form of gonorrheal ophthalmia, and in the infant as ophthalmia 
neonatorum, is produced in both varieties by the introduction into 
the eye of a specific virus from either the urethra or the vagina. The 
chief danger of the disorder is destruction of the vitality of the 
cornea and loss of sight. The most important indication is to pre- 
vent this danger by reducing the amount of swelling of the lids and 
conjunctiva and the profuse discharge, which are the characteristics 
of the disease. These indications are met best in the following man- 
ner : Hourly cleansing of the eyes with an antiseptic solution, pref- 
erably bichloride of mercury (1 to 7000), or a saturated solution of 
boracic acid. During the acute inflammatory stage, and before the 
discharge is profuse, astringents and cauterants must not be applied. 
When this stage has arrived, and the conjunctiva is profusely cov- 
ered with discharge, the lids should be carefully everted once a day, 
wiped clean of every particle of pus, and carefully touched with a 
solution of nitrate of silver (grains 10 or 20 to the ounce), and the 
excess neutralized with a few drops of a solution of common table 
salt. In the early stages, iced compresses wrung out of carbolized 
water and frequently changed, will help to reduce the reaction, or 
these compresses may be made by placing squares of lint upon a 
block of ice and thus securing intense cold. If the vitality of the 
cornea is threatened it is advisable, in many instances, to substitute 
for the cold applications hot compresses of a temperature of 110° F. 
These may be applied for from ten to twenty minutes every two or 
four hours, according to the exigencies of the case. The appearance 
of ulceration in the cornea calls for the use of either atropine or 
eserine. Atropine was formerly employed almost exclusively ; in re- 
cent times great success has followed the adoption of eserine. This 
is especially applicable if the ulceration should form in the periphery 
of the cornea. In adults, high reaction and violent inflammation may 
be alleviated by the use of leeches to the temple. Bleeding of any 
sort is not applicable to newborn infants. Other applications which 
have. met with favor at the hands of various surgeons are solutions 
of sulpho-carbolic acid, sulphate of alum, sulphate of zinc, nitrate of" 



382 DISEASES. 

silver, creolin (1 per cent.), and iodoform ointment. Miles has es- 
pecially recommended a treatment with alcohol and corrosive subli- 
mate. The preventive method of treating ophthalmia neonatorum 
that has obtained the happiest results is that instituted by Crede, 
namely, the dropping of a two per cent, solution of nitrate of silver 
into the eyes of the newborn infant. If one eye alone is attacked 
in gonorrhoea! ophthalmia the other should be protected by covering 
it with Buller's shield, which consists of a watch-glass fixed in a 
square of plaster, which is carefully applied so that the crystal comes 
directly in front of the eye, and the plaster covers the surrounding 
area. 

Xerosis of the conjunctiva, depending upon a cicatricial metamor- 
phosis and the absence of normal moisture, is seen after long-stand- 
ing inflammations (granular lids, diphtheria, pemphigus), and is in- 
curable. The affection may be relieved by the local use of glycerin, 
almond oil, emulsion of cod- liver oil, or the use of weak alkaline 
solutions. Transplantation of the rabbit's conjunctiva has been 
tried without success. 



CONSTIPATION. 

This troublesome state depends on a number of causes, the most 
common of which is the following of a sedentary life totally devoid 
of the exercise intended to keep active intestinal and hepatic secre- 
tion. Another frequent cause is simple laziness, which causes the 
patient to resist the call of the bowel for evacuation until this part 
of the body beomes indolent and atonic, while modesty often causes 
the condition in females, because a woman prefers to suffer rather 
than go to a closet which may be somewhat publicly situated. In 
other instances constipation seems to be hereditary and to depend 
upon deficient nerve-supply, or muscular weakness and lack of secre- 
tion in the lower bowel, or to hepatic torpor. 

Whatever the causes are they should be sought after and, if possi- 
ble, removed, the physician not being content to order purgatives 
which, while they may give temporary relief, soon lose their power. 

Further than this, it must be remembered that hygienic measures 
always take first place in the method of treatment, and, if possible, 
drugs should carry out a very secondary role. Particular attention 
should be paid to diet and the physiology of peristalsis must be well 
borne in mind. 

It has been proved by a large number of studies, both in the 
ordinary gut and by the use of purgatives, that peristalsis is almost 
entirely a reflex action depending for its existence upon the integrity 
of the nervous plexuses in the intestinal walls, namely those of Atier- 
bach and Meissner, the first of which are situated between the longi- 



CONSTIPATION. 383 

tudiual and circular muscular fibres which they supply, the latter 
existiug in the submucosa and supplying the walls of the villi, the 
glands of Lieberkuhn, and the small arteries and venules. 

It has also been found that the vagus nerve, when stimulated 
reflexly or directly, increases peristalsis, and that moderate stimula- 
tion of the splanchnic decreases it. 1 It at once becomes evident that 
any decrease in the normal activity of these nerves and nerve centres 
must speedily result in constipation, and the costive condition con- 
sequent upon hepatic torpor is due to the fact that the intestinal 
walls do not receive the proper stimulation from the bile to set in 
motion a reflex wave, the result of which will be purgation. This 
fact rests upon direct experiment that proves the bile to be primarily 
au intestinal stimulant, antiseptic, and promoter of secretion. 

Other series of experiments have found that the circulation of the 
blood through the intestines greatly influences peristalsis, and dis- 
orders in the blood-supply readily bring on intestinal disorder. 

The deductions to be drawn from these facts are many. In the 
first place, it is evident that the maintenance of an active, normal 
circulation of blood in the abdomen and a free pouring out of bile 
from the liver and gall-bladder is necessary to healthy peristalsis, 
and we find that aside from drugs we have a number of remedial 
measures which are to be resorted to according to the means of the 
patient. By far the best of these is horseback exercise for at least 
an hour a day, or every other day, which, by the motion, readily 
stirs up and excites the abdominal viscera as no other measure can 
do. If for any reason horseback exercise is impossible, then abdomi- 
nal massage carried out by a capable masseuse is to be tried, the 
hands following more particularly the course of the ascending, trans- 
verse and descending colon, and the kneading movements being de- 
voted to the hypochondriac regions. If neither of these measures can 
be used then the patient must resort to those gymnastic movements 
which involve the abdominal muscles, either by the use of dumb- 
bells or pulleys, such as are sold under the name of " home gym- 
nasiums," or by bending the body forward, backward, and laterally 
with the fists pressed into the hypogastrium. 

At the same time that these measures are directed the diet of the 
patient must be so regulated that the food shall contain a large 
amount of residue — that is, after digestion enough of the husk of the 
grain or enough vegetable fibre must be left free in the intestines to 
form a stimulus to the intestinal wall. If a meat diet is largely used 
so little residue is left after digestion that constipation ensues, but it 
vegetables are largely eaten the reverse is the case. No better evi- 
dence of this can be adduced than the hard clay-like passages of the 
dog and the soft passages of the cow. Very often a plate of cracked 

1 Some persons believe that Meissner's plexus receives impulses from the walls of 
the intestine and transmits them to the motor plexus of Auerbaeh, which then set in 
motion peristalsis. 



384 DISEASES. 

wheat (wh eaten grits) at breakfast each morning, or the use of bran 
bread, will relieve a chronic tendency to constipation. In these 
cases, above all things, milk is to be avoided, since it is almost 
entirely assimilated and leaves no residue though it supplants other 
foods. Green or canned corn is of great service. Fruits do good in 
constipation in one of two ways, either they contain residuous 
materials or sufficient vegetable-acid salts to be laxative. Figs, by 
reason of their many small seeds which scrape the mucous membrane 
during peristalsis, are particularly valuable, and apples, prunes, 
dates, and tamarinds are all useful. It must be remembered that 
strawberries, raspberries, and blackberries are generally constipating 
rather than purgative. In regard to drink, nothing is so good as a 
cold glass of water taken on arising in the morning or just before 
breakfast, or if the cold cannot be borne then a glass of as hot water 
as can be Svvallowed may be substituted. Coffee is constipating to 
most persons, largely because of its empyreumatic oil, and tea has the 
same tendency because of its tannic acid. Brandy, as every one 
knows, is distinctly constipating, and whiskey possesses so little 
power to the contrary as to be valueless. Beers differ in their 
properties, some of them increasing and some of them decreasing 
intestinal activity. 

The patient suffering from constipation should go to stool regularly 
after breakfast every day, even if the attempt is abortive and so 
train the bowel to expect a movement at that time. 

The use of drugs for the relief of constipation is capable of division 
into two parts. First, the employment of remedies to unload the bowel 
which has become filled ; second, the use of drugs which will so influ- 
ence the intestines as to cause evacuation and normal activity, or, in 
other words, drugs which will cure the tendency instead of giving 
temporary relief. Of the first class we find the various purgative salts, 
jalap, colocynth, senna, mercury in all its forms, castor oil, and rhu- 
barb ; of the second class, aloes, cascara sagrada, manna, tamarinds, 
rhamnus frangula (Buchthorn), phosphate of sodium, and small doses 
of podophyllin. The physician should bear in mind that defecation is 
a normal, physiological act which must be continued all through life, 
and it is almost as foolish to stimulate the bowel continuously to 
peristalis as to employ perpetually heart stimulants or respiratory 
excitants. 

Although they are habitually employed in daily doses the purga- 
tive salts are exceedingly harmful in such instances, rapidly losing 
their power and decreasing the patient's strength by the abstraction 
of liquids and salts from the blood. They often produce anaemia 
when constantly used. These salines are to be employed simply to 
unload the bowel when an excess of faecal matter has accummulated, 
or when irritant materials are to be swept out of the alimentary 
canal. In some rare instances, where great plethora exists, a course 
of Hunyadi water, Fried richshall or Carlsbad waters is of service, 



CONSTIPATION. 385 

but these are indeed rare instances iu America, Jalap, colocynth, and 
senna are not to be used constantly, as they are too active, and the 
reaction frum their effects causes constipation. Rhubarb is com- 
monly used, but is of its class peculiarly unfitted to its task. Although 
it purges it is distinctly astringent, and is therefore more constipat- 
ing in the end than if no drug was used. 

Mercury is exceedingly harmful if used as a continued purge and 
is the cause of much ill-health, bad teeth, and digestive troubles. 
Castor oil is notorious for its tendency to cause ultimate constipation. 

Of the curative class of laxatives none compare to cascara sagrada, 
particularly in the form of the tasteless fluid extract or cascara cor- 
dial. Originally this drug as prepared was very bitter but it is now 
made almost tasteless by certain manufacturers. This is the only 
drug which alone moves the bowels and at the same time tends to 
make future passages more easy and regular ; the dose is 10 to 20 
drops of the fluid extractor 1 drachm to 3 of the cordial. There is 
almost no griping produced by it. For the regulation of the bowels 
of young children, particularly if they are somewhat "rickety" in 
tendency, phosphate of sodium in the dose of 5 to 10 grains in milk 
is the best laxative and the same salt may be used in 30 to 60 grain 
doses in adults. Manna is to be classed as a laxative fruit, but even 
it sometimes makes the intestinal torpidity ultimately much worse. 
The two remaining drugs of this class, aloes and podophyllin, should 
always be used in combination with other non-purgative drugs, as is 
seen in the following formula? : 



]£ . — Aloes soc. 




. gr. xx. 


Ext. nuc. vom. 


. 


. gr. iv. 


Ext. physostig. 
Ext. belladon. 




• gr. iij. 
. gr. iv. 


M.--Et. in pil. JSTo. xx. S. 
It. 


One pill at night or night 


and morning, 


R. — Kesinse podophylli 




. gr. ij. to iv 


Ext. nuc. vom. . 


. 


. gr. iv. 


Ext. physostig. . 
Ext. belladonnas 




• gr- jij- 

. gr. iv. 


M.— Ft. in pil. No. xx. S. 


One as above. 





The object of using these other drugs is seen at a glance. We 
have already learned that nearly all purgatives tend to produce 
griping. The mix vomica acts as a bitter tonic and stimulant and pre- 
vents subsequent atony of the mucous membrane as well as increases 
reflex action and consequently improves peristalsis. The physostigma 
is a tonic to the unstriped muscular fibre and gives it strength j the 
belladonna aids peristalsis by depressing the inhibitory fibres of the 
splanchnic nerves by allaying spasm and by decreasing griping. In 
using these drugs, aloes and podophyllin, we should remember that 
aloes is slow and acts particularly on the lower bowel, and that podo- 

25 



386 DISEASES. 

phyllin acts chiefly on the upper bowel and is the slowest purge in 
the list of purges. 

In the flatulence of old persons associated with constipation a little 
asafcetida or capsicum should be added to the pill of aloes just named. 

In some instances constipation arises from reflex irritation, as ova- 
rian or bladder trouble. This form may resist all purgatives and 
yield to opium or to tobacco which quiet reflex action. Tobacco de- 
presses the inhibitory nerves of the gut, and devotees of the " weed " 
often use it as a laxative. 

The employment of enemata is to be discouraged as a routine 
practice. In cases where it is necessary to use them for temporary 
relief, and to get rid of flatulence, a little soap, common salt, or a 
few drops of turpentine may be added to the water. Kecently the 
injection of glycerin (1 to 2 ounces) has been largely resorted to, 
either pure or diluted one-half and this method has been improved 
upon by the use of glycerin suppositories containing several drops of 
the drug. Glycerin acts in these cases as an irritant to the mucous 
membrane and causes secretion by this means and its abstraction of 
water from the tissues which it carries out by reason of its hygro- 
scopic powers. 

CORNS. 

These troublesome formations are best treated by the use of sali- 
cylic acid, the following formula being applied night and morning 
for several days, after which the part should be well soaked in hot 
water when the entire corn will readily come away, or in some cases 
several attempts will be necessary. 

^. — Acid, salicylic gr. xxx. 

Ext. cannabis indicse . . . . . . gr. x. 

Collodii. f ^ ss. 

M. — S. Apply with a camel'a-hair brush. 

The same acid may be used in alcohol, and lactic acid in the same 
proportion is often of service. 

In the so-called u soft-corns " with much inflammation the foot 
should be washed and dried, and a saturated solution of nitrate of 
silver, 60 grains to the drachm, applied to the part every four or five 
days. 

OORYZA. 

Coryza, or ordinary cold in the head, is an acute inflammation ot 
the mucous membrane of the nose ; a disease of so frequent occur- 
rence during our changeable spring and winter months that it rarely 
receives the attention that it deserves. As it is in most cases the 



CORYZA. 387 

point of departure from health toward chronic nasal catarrh, its 
complete cure, in each instance, is a matter of importance. 

Among the causes of coryza are exposure to cold or dampness, wet 
feet, checking secretions, and lowering the tone of the mucous mem- 
branes by inhaling close or impure air. It is also caused by inhaling 
dust, acrid vapors or gases, as bromine, chromic acid, and pyrethrum, 
or Persian insect powder. 

Permanent changes occur in the nasal mucous membranes where 
the exposure to irritation is long continued. 

Hay-fever subjects are liable to attacks of coryza from very slight 
causes during any part of the year, the susceptibility increasing, how- 
ever, as the season approaches for their periodic outbreaks. The 
exciting agent is usually in the form of dust of some kind, though 
all are not equally sensitive to the same irritant. The rose, the 
peach, the golden-rod, and rag- weed each has its victim. The writer 
once treated a woman who could work in wheat flour with impunity, 
while the same exposure to rye flour at any season of the year pro- 
duced a violent attack of coryza with uncontrollable fits of sneezing 
and running from the eyes and nose. By removing the cause and 
retiring to a quiet, cool room these attacks would pass off in a short 
time without any other treatment. It is possible to multiply the 
description of cases of this nature, but their consideration comes 
more appropriately under the head of vaso-motor disturbances and 
hay-fever. 

Coryza usually commences with a creeping sensation, with or 
without a distinct chill, followed by constitutional disturbance, as 
fever, dry, parched skin, pain and aching in the back and limbs. 
Urine high colored and scanty. Frontal headache varies in intensity 
from an acute lancinating pain to a dull ache or throb over the 
brow, increased by leaning forward. The nose and throat at first 
are dry and parched, the tongue literally " cleaving to the roof of 
the mouth." 

Sneezing, which may occur prominently from the first, is followed 
by a profuse watery discharge from the nose and eyes. The erectile 
tissues on the turbinated bones become engorged with blood, pro- 
ducing complete obstruction to breathing. When the swelling causes 
excessive pressure, the intranasal tissues may become cedematous. 

Pressure to this degree, stretching the turbinated tissues and im- 
pinging upon the delicate sensory nerves of the septum, causes acute 
headache, centring over the frontal sinuses or the cheek bones, hav- 
ing a neuralgic tendency to shift its position. The eyes are injected 
and become suffused on the least exposure to light. Mild delirium 
may supervene upon pressure in the upper turbinated region, the 
roof of which, we must remember, is only separated above from the 
base of the brain by the cribriform plate of the ethmoid bone. 

The filaments of the olfactory nerve, piercing the cribriform plate 
of the ethmoid bone, are distributed to the upper turbinated and the 



388 DISEASES. 

upper half of the middle turbinated bones, and on the septum to 
about the same level. This region, called from its function, olfactory, 
appears in health slightly lighter in hue than the region below, which 
is mainly respiratory in function. 

A few of the reflex disturbances, resulting from chauges in intra- 
nasal 'pressure, will be considered elsewhere. 

An intense itching of the end of the nose is, with some people, 
the first indication of an approaching cold in the head. Such people 
usually have an abundauce of stiff hairs in the orifice of the nostrils, 
and, stimulated by the extra blood-supply to their roots, these hairs 
gradually erect, and, in doing so, tickle the already hypersensitive 
membrane of the vestibule of the nose. 

During this stage of hypersecretion the amount of watery fluid 
discharged from the nose is very great, containing in addition to the 
secretion from the mucous glands, exfoliated epithelial cells, leuco- 
cytes, and saline constituents from the blood. The free discharge and 
constant use of the handkerchief may excoriate the upper lip and 
alee of the nostrils, addiug to the general discomfort. 

The rapid draining of serum produces a degree of weakness and 
vital depression, apparently disproportionate to the severity of the 
disease, the exhaustion being indicated by loss of weight and strength, 
and by pallor. 

After a variable period the discharge becomes thicker and less 
copious, muco-purulent in appearance, and, under favorable condi- 
tions, completely disappears in a week or ten days, the discharge 
gradually drying up, and the swollen membranes regaining their 
natural tone. 

Under less favorable conditions, as in strumous subjects, resolution 
takes place more slowly, and the discharge remains muco-purulent 
or purulent for an indefinite period. 

The tissues remain more or less thickened, leaving a permanent 
contraction of the calibre of the nostrils, with slight difficulty in 
breathing through the nose. A renewal of the cold at this time and 
increased infiltration or relaxation of the submucous connective 
tissue leave still greater obstruction. The tendency to recovery is 
lost, and the condition has become one of hypertrophic nasal catarrh. 
Inspection of the interior of the nose shows the tissues at first dry 
and red. The ends of the turbinated bones appear as puffy, red 
cushions. This congested state may extend to the vault of the 
pharynx and involve the orifices of the Eustachian tubes, and lead to 
a train of ear symptoms. 

During the stage of secretion the membranes become very much 
swollen. The erected turbinated tissues completely close the lumen 
of the nostrils and press firmly against the septum. The same state 
exists at the back of the nose, and the tissues on the lower or middle 
turbinated bones may even project into the naso-pharynx, the whole 
interior surface being bathed with secretion, either serous or muco- 



CORYZA. 389 

purulent, according to the state of the disease. The intense swelling 
makes an examination rather unsatisfactory at this period. The 
mucous membrane remains slightly reddened for some time after 
apparent recovery takes place. 

The usual method of treating cold in the head is with " contempt." 
The patient, as a rule, takes the law into his own hands, only seeking 
medical advice when an attack of unusual severity arouses his fear 
of catarrh. 

Prompt treatment will often abort an attack of coryza, and, failing 
in this, will cause it to run a shorter and milder course. 

When it is the result of chilling the surface of the body, a Turkish 
bath may be taken at once. Should this be inconvenient, or too 
active, a hot mustard foot-bath, with a hot draught or Dover's pow- 
der may be sufficient, with rest in bed, to bring on perspiration and 
a complete relief. 

Whiskey, by its power of increasing the capillary circulation of the 
skin, is a useful remedy, especially where the heart is weak. 

It has been clearly proved that whiskey is not equally efficient in 
preventing an attack, as the first glow is followed by a stage of de- 
pression, during which, the resistance to exposure is lessened. 

The inhalation of steam charged with such volatile substances as 
camphor, cubebs or benzoin, may give relief to the congested mucous 
membranes. Quinine by its action on the nervous system often 
gives good results, and is universally employed by the laity. 

As mucous congestions frequently result from a torpid liver or 
overloaded bowel, good often occurs from small doses of calomel, or 
a blue pill, followed by a saline laxative. The saline purge alone, 
by its revulsive action is often of benefit. Efforts to restore any 
suppressed secretion should be instituted at once. 

Atropine in small doses has given me excellent results, employed 
during the stage of free watery secretion. It may be combined with 
small doses of morphine, employing quinine at the same time. 

Locally, the use of a mild, alkaline or antiseptic wash gives relief, 
by reducing the inflammation and cleansing the parts from secretion. 
The following, which is a modification of the well-known " Dobell's " 
solution, meets the requirements : 

R. — Acid, carbol. (crys-t.) gr. x to xv. 



1 



Sodii bicarb. 

Sodii borat. J aa * 5J- 

G-lyceringe . . . . . . . . f^j. 

Aquas q. s. ad. Oij. — M. 



This solution may be used by gently drawing it up the nose, or as 
a spray from a hand atomizer. When the odor of carbolic acid is ob- 
jectionable, it may be substituted by menthol, thymol, and eucalyptol 
in very small quantity. When the membrane is too much swollen to 
admit such a spray, the local application of a 2 or 4 per cent, solution 
of cocaine will contract the tissues long enough to allow the employ- 



390 DISEASES. 

ment of other means. Cocaine gives great temporary relief, but its too 
frequent use appears to increase the congestion afterward. 

The alkaline wash may with advantage be followed by the insuf- 
flation of the following anodyne powder, known as Ferrier's snuff: 

R. — Morph. sulpb gr. v. 

Bismuth spj. 

Acaciae gss. 

Fluid cosmoline sprayed into the nose, after cleansing it from secre- 
tions, has a soothing effect. The use of severe measures, as irritating 
snuffs, while they deplete the tissues by increasing the flow, only in- 
tensify the inflammation afterward. 

The nasal douche should be avoided in all conditions of obstruc- 
tion in the nostrils, especially in obstruction to the outflow of liquids. 
As a rule, solutions are carried into the nose more readily than from 
it, and in such a case the hydraulic pressure may force the fluid into 
the Eustachian tube. This accident is fortunately rare. The writer 
has the record of only one such instance, in which a physician using 
the douche for the first time, suddenly felt the water rush into one ear ; 
the hearing was instantly lost and never recovered. The accident 
occurred some years ago, and the exact condition was not ascertained 
at the time. 

After recovery from coryza, tonics, and especially iron, should be 
employed to fortify the system against a repetition of the attack. 

Important prophylactic measures consist in exercise in the fresh 
air, cheerfulness, attention to the state of the skin, the use of woollen 
underwear, avoidance of dissipation, late hours, reading with the 
head near a hot lamp, dust, draughts, or anything which lowers the 
vital forces. 



CROUP, MEMBRANOUS, AND DIPHTHERIA. 

According to a number of prominent physicians, diphtheria is at 
first a distinctly local disease, the membrane in the throat forming a 
nidus from which the entire body becomes ultimately filled by the 
microorganism peculiar to the malady, while others regard the local 
lesion simply as an evidence of systemic involvement, but as the 
treatment employed by the best practitioners is almost identical in 
both cases the author has seen fit not to recognize this conflict of 
opinion. 

The treatment of the throat-changes before the membrane appears 
should consist in sufficiently large doses of belladonna to impress the 
system, and it is to be accompanied by painting the pharyngeal wall 
with a solution of chlorate of potassium of the strength of 15 grains to 
the ounce, or if this seems too strong only 5 grains to the ounce may 
be employed. After the membrane is formed its dissolution may be 
carried on by the use of the atomizer spray with lime-water or with 



CROUP, SPASMODIC. "391 

lactic acid solution of the strength of 30 grains to the ounce every 
hour. In other instances a solution of trypsin, one of the ferments 
of the pancreatic juice, may be used on a swab or spray to digest the 
membrane. Other cases do well when a solution of boracic acid is 
applied dissolved in glycerin in a water-bath in the strength of 1 to 
30 and applied to the membrane. 

By far the best thing for the physician to do to prevent or limit the 
exudate, is the judicious use of mercury. This is to be done by 
employing -j 1 ^- to J of a grain of corrosive sublimate, or by using 
calomel J to J of a grain every hour, until the evidences of the action 
of mercury are shown by the loose stools. It is said that the stools 
following this use of corrosive sublimate in diphtheria resemble 
" frog spawn" — that is, are frothy looking. The object in using 
the mercury is to cause a lack of plasticity in the blood and so to 
decrease the exudation of fibrine. Having made this attempt, which 
is only to be tried in sthenic cases, supportive measures are to be 
resorted to and for this purpose tonics and stimulants with nourish- 
ing food are to be employed. Tincture of the chloride of iron, qui- 
nine, and strychnine are of service to keep the kidneys active, to 
stimulate the heart and respiration, and to support the vital forces. 
The food should consist in pancreatized and sterilized milk. The 
object is to keep the bacteria limited to the throat, yet with every 
drink of ordinary milk they are taken into the stomach in a culture 
medium. It is always best to use an antiseptic spray or swab before 
giving the sterilized milk, to render the mouth so far as possible 
antiseptic, and to avoid the gagging, which may cause vomiting of 
the food if the swab is used afterward. 

Hundreds of other measures have been recommended and em- 
ployed until almost every one has his favorite method, but the ones 
here given will be found most generally advantageous in the majority 
of cases. Where the glands of the neck threaten to suppurate, ice- 
bags should be applied to the throat and pieces of ice held constantly 
in the mouth while the tincture of iron is pushed in as full amounts 
as possible. 

If suifocation is imminent, inhalations of oxygen are to be used 
and atropine or strychnine employed, although tracheotomy may be 
necessary. 

Chlorate of potassium must never be given internally, as the kidneys 
are already severely inflamed, and this drug is not only useless when 
so given but in addition a renal irritant. 



CROUP, SPASMODIC. 

As this is a spasm of the glottis depending for its causation 
upon catarrh of the mucous membrane of the larynx, and as it 
is due most commonly to some reflex irritation, such as dentition, 



392 DISEASES. 

indigestible food, or sudden atmospheric changes, the treatment is 
both prophylactic and curative. Prophylaxis consists in the avoid- 
ance of cold, the use of a simple diet, particularly at the evening 
meal, the rendering of the air of the bedroom moist by means of 
steam, or at least by the avoidance of dust-laden, furnace-heated 
air, and by the removal of dental irritation, and nasal hypertro- 
phies, which make the child a "mouth-breather/' Small doses of 
the bromides, chloral, belladonna, and of opium, may be resorted 
to at bedtime. When the attack is present, a cold cloth should be 
wrapped about the neck and the child placed at once in a hot bath, 
the air of the room being moistened by the steam escaping from a 
kettle of boiling water. If the paroxysm is very severe a few whiffs 
of amyl nitrite may be employed or antimony may be used in suf- 
ficient dose to cause vomiting. 

The drugs first named do good by decreasing reflex excitability, 
while the emetics relax the spasm indirectly by the nausea and 
depression which they produce. 



CYSTITIS, ACUTE. 

If, by reason of injury, the introduction of foreign bodies, such as 
dirty catheters, the presence of gonorrhoea or other poison, an acute 
inflammation of the bladder ensues, it is always accompanied by a 
sensation of weight and vesical fulness, by pain, tenesmus, and ina- 
bility to restrain the urine. Sometimes the reverse may be true, and 
retention of the urine is present. 

If the general system responds to the local inflammation, as is 
evidenced by increased arterial excitement and fever, aconite, in full 
doses of the tincture, should be used, and it may be combined with 
small amounts of sweet spirit of nitre and citrate of potassium, as 
follows : 

R. — Tinct. aconiti f.£j. 

Spirit, sether. nitrosi . . . * . . f.^j. 

Liq. potas. citratis . . . . . q. s. f^vj. 

M. — S. Dessertspoonful every four hours until all fever ceases and the pulse 
is quiet. 

At the same time, a hot compress should be applied over the blad- 
der, but it should not contain turpentine or any irritant substance 
which may be absorbed from the skin and when eliminated by the 
kidneys irritate the bladder walls. In some cases belladonna may be 
used with or without aconite in the dose of 5 to 10 drops of the tinc- 
ture three times a day, and this drug is particularly serviceable in the 
cystitis due to cold ; 5 drops of liquor potassa every four hours may 
be substituted for the citrate of potassium, or the acetate of potassium 
may be used. If there is much pain and bearing down, an enema of 



CYSTITIS, CHRONIC. 393 

30 drops of laudanum in 2 ounces of starch-water may be employed, 
or the opium may be given in suppository. 

Sometimes a belladonna suppository is of more service, and an 
iodoform suppository will often relieve the pain by its local anaes- 
thetic effects. Hot enemata, without any drugs, are often valuable 
as a means of relief, and a hot sitz bath is very efficacious. Canna- 
bis indica, if an active preparation can be had, is better than opium 
to relieve the pain, since it seems particularly to affect the bladder. 
The other curative measures are hygienic, and consist in the mainte- 
nence of the recumbent posture, absolute physical and mental rest, 
the avoidance of all foods which are stimulating, as rare meats and 
highly seasoned dishes, and abstinence from all varieties of alcoholic 
beverages. 

Laxatives are to be employed with persistence if the bowels are 
confined, and salines in the early stages are generally better than 
vegetable purges. 

Quinine should not be used for the fever, as it is contra-indicated, 
owing to its irritant effects upon the bladder. 



CYSTITIS, CHRONIC. 

The treatment of chronic cystitis is entirely different from that 
of the acute form, and consists in the use of remedies which 
will stimulate the diseased mucous membrane, cause a normal secre- 
tion of mucus, and so influence the urine that the mucus already 
formed will be passed out and the fluid rendered alkaline or acid, 
as may be desired. When mucus is persistent in large amount the 
urine should be rendered alkaline by the use of liquor potassa, or 
the citrate, acetate, or bicarbonate of potassium. The bitartrate of 
potassium is eliminated as the bitartrate of potassium, and, as it is 
acid, cannot be used. The purpose of acidifying the urine lies in the 
necessity of dissolving the phosphates and preventing deposits in the 
bladder and elsewhere. The two best drugs for this purpose are 
boracic acid, in the dose of 5 to 10 grains, and benzoic acid, in the 
same amount. Both of these may be given in pill form, made by 
adding a little glycerin. The rule may be laid down that, if the 
urine is high colored and is strongly acid, alkalies are useful ; whereas 
if it is clear, but loaded with phosphates, the acids named should be 
employed. 

One of the best measures in chronic cystitis is to wash out the 
bladder daily, by irrigation, with warm water, or w r ater containing 
bichloride of mercury in the proportion of 1 to 10,000, as this 
washes away all mucus and uric-acid deposits, and prevents irritation. 
Solutions of nitrate of silver have been used with great success where 
the discharge is muco-purulent, and Thompson recommends the use 



394 DISEASES. 

of a solution of the strength of 1 grain to 4 ounces of water, gradu- 
ally increased to 2 grains to the ounce. Others, such as Gardner, 
Richardson, and Potter, recommend the use of stronger solutions, 5 
grains to the ounce of water, claiming that while they may produce 
serious effects they are very efficacious in obstinate cases. The 
physician should have at hand a solution of common salt, which he 
should inject into the bladder at once if the action is too painful or 
excessive. This treatment is only suited to the most chronic cases. 

The remaining remedies which are employed in chronic cystitis 
are those which are directed to the improvement of the mucus mem- 
brane of the bladder, and consist in buchu in the form of the fluid 
extract in the dose of J to 1 drachm, well diluted, arbutin or ursin, 
3 to 5 grains, or the fluid extract of uva ursi, dose 30 drops to a 
drachm. All of these are better fitted for the treatment of subacute 
than chronic cystitis, as they are not sufficiently active for the chronic 
forms 

In cystitis of an advanced type, with great vesical atony, strych- 
nine is of service, and drop doses of tincture of cantharides do great 
good. Turpentine may also be used with advantage in 5 to 20 drop 
doses, as may also the oils of eucalyptus, sandalwood, cubebs, and 
copaiba. 



DIABETES INSIPIDUS. 

In diabetes insipidus the condition exists simply as a profuse urin- 
ary flow dependent upon some disorder of the innervation of the 
kidney, or upon atony or relaxation of this organ. The treatment 
consists in the use of astringents and tonics, and in some cases in the 
employment of opium or belladonna, particularly if the over- secretion 
rests upon nervous irritability. Gallic acid may be used in 20 grain 
powders three times a day, and the fluid extract or wine of ergot is 
often of service given in the dose of 30 drops to a drachm of the 
former or a wineglassful of the latter. As tonics the sulphate of 
iron and strychnine are indicated. 



DIABETES MELLITUS. 

The treatment of diabetes mellitus is dietetic and medicinal. The 
diet list should be made largely of meat, particularly if some fat be 
attached to it, as the fat takes the place of starch in the body. The 
avoidance of starches of all kinds, and the use of dry wines or those 
containing little or no sugar is to be insisted upon, and beers and 
malt liquors must be forbidden. According to some authorities, the 
patient should be put to bed and put on a purely milk diet, generally 



DIABETES MELL1TUS. 395 

of skimmed milk, although buttermilk is better thau auy other 
form, owing to its lactic acid and lack of sugar. Koumyss for the 
same reasou is very valuable. The chief aim of the patient must be 
to avoid all substances which can be readily converted into sugar by 
the organism. 

The following list of foods mav be taken, and the second list for- 
bidden. 1 

Meats of all kind except liver, eggs, fish, cheese, butter and cream. 
Oyster plant, asparagus (?), tomatoes, almonds, pecan nuts, butter- 
nuts, walnuts and cocoanuts. String-beans, beet tops, radishes, 
mushrooms, lettuce and water-cress, cauliflower, spinach and onions. 
Celery and cucumbers may also be permitted. 

Of the foods to be avoided we have all forms of sugar, all forms 
of starch, such as ordinary flour, cornmeal, arrowroot, sago, tapioca, 
oat-meal, barley, carrots, beets, parsnips, pie plant, peas and beans, 
chestnuts and most of the fresh fruits, cider, beers, champagne, sw r eet 
wines and honey. 

The treatment of diabetes by drugs is varied by the condition of 
the patient, the cause of his disease, and the quantity of sugar in the 
urine. While the drugs most commonly employed are used in many 
instances without any knowledge of how they act, and have each of 
them a set of w r arm supporters among prominent authorities, much 
of the treatment must depend upon whether or not a rheumatic or 
gouty taint is the cause of the trouble or whether it is due to high 
living, little exercise, and a plethoric, congested, overloaded system. 
In the first class of cases iodide of potassium and the salicylates will be 
most serviceable ; in the second class, a restricted diet, moderate exer- 
cise, and purgation to relieve engorgement of the hepatic artery and 
veins may be needed. In the cases of gouty diabetes, where relief does 
not follow the use of the iodides and colchicum, resort must be had 
to arsenic and lithium citrate or carbonate, a combination peculiarly 
adapted to such a condition according to several authorities. Indeed 
arsenic is a sheet-anchor with many practitioners in all forms of 
diabetes, and should be given in fairly large, constantly repeated doses 
for a long time. A very much larger body of medical men believe 
in opium, or one of its alkaloids, codeine. The former is used in the 
dose of J to J grain three times a day; the latter 1 to 5 grs. t. d. 
The chloride of gold and sodium (y 1 ^- grain) has been highly recom- 
mended by Bartholow, and ergot by Wood and DaCosta. In cases 
depending upon rheumatism the use of salicylic acid is often of great 
value, the dose beiug 10 to 15 grains three times a day. 

The excessive thirst of diabetics can be best allayed by the use of 
acidulated water or alkaline waters, containing non-purgative salts. 
It is useless to cut off the water-supply to the production of great 

1 It is worthy of note that certain persons may have a slight glycosuria without 
serious injury, who waste under a limited diet, requiring ordinary fare to supply the 
body plus the diabetic drain. 



396 DISEASES. 

suffering, bat the patient should use moderation in drinking as far 
as possible. 

The wasting coming on in diabetics is to be treated by careful diet, 
rest, and the supply of all the food which the patient can digest. In 
mauy instances the amount of aliment ingested is extraordinarily large, 
while in others digestion is so impaired that food cannot be taken. 

If cachexia comes on, iron, strychnine, bitter tonics, the lacto-phos- 
phates of lime and sodium and astringents are to be used to support 
the circulatory and nervous systems. Tea and coffee and all forms 
of foods needing sweetening, may be rendered palatable by the use 
of saccharin or of glycerin. The former passes through the body 
unchanged, the latter increases the glycogen in the liver but checks 
the formation of sugar (Ransom). 

Unfortunately we do not know the innermost causes of diabetes, 
nor the manner in which the glycosuria is brought about, and in 
consequence cannot explain the manner in which opium, codeine, or 
other drugs produce relief. 



DIARRHOEA AND DYSENTERY. 

Diarrhoea is a term loosely applied, with perfect correctness, to all 
forms of intestinal disturbance accompanied by the passage of liquid 
stools, and its meaning " to run through " expresses the state it 
represents. (See Cholera Morbus.) 

The treatment of each form of diarrhoea depends upon its cause, 
and no case can be intelligently treated in which the physician fails 
to recognize this aspect of the case. Diarrhoea is but a symptom, 
not a disease, and must be regarded solely as an evidence of intestinal 
disorder. 

While the same drugs are prescribed in many forms of the trouble 
we may divide these conditions into four classes as follows : (a) Those 
in which the laxity is due to a catarrh, acute or chronic, of the in- 
testinal mucous membranes, causing the passages to contain mucus. 
(6) Those where, owing to disordered innervation, a profuse outpour- 
ing of liquid takes place from the bloodvessels into the intestinal 
lumen, (c) Those in which, owing to disease, the glands fail to 
prepare the food properly ; and finally (d) those cases where ulcera- 
tion causes irritation and bloody purging. 

The treatment of the catarrhal form first named consists primarily 
in the regulation of the diet, which should be made up chiefly of 
milk, boiled or predigested, and in the administration of castor oil 
or other mild purge to sweep out fermentating mucus. Enough 
laudanum should accompany this oil to prevent griping, and it is well 
to add bicarbonate of sodium, grains 20 to 30, to the dose, both to 
aid the action of the oil and to render the bowel alkaline in reaction 



DIARRHCEA AND DYSENTERY. 397 

(normal) in place of acid, as caused by the fermentation abnormally 
present. A mustard plaster or other counter-irritant should be ap- 
plied to the abdomen. Often in the milder forms of mucous diar- 
rhoea this is all that is needed, but more frequently it must be followed 
by the use of tonics and astringents, such as nitrate of silver and 
hyoscyamus in the following pill : 

R. — Argenti nitratis gr. ij. 

Ext. hyoscyam. ....... gr. v. 

M. ft. in pil. No. x.— S. One t. d. 
Or, 

$ . — Plumbi acetai. ....... gr. ij. 

Ext. opii . . . . . . . . gr. ij. 

M. ft. in pil. No. x. — S. One t. d. 

If these stop the diarrhoea and there are still seems to be a ten- 
dency for it to return, or atony is present, we should use a pill con- 
taining the extract of chiretta, or nitro-muriatic acid, or better still, 
nitric acid and cardamoms. 

&. — Acid, nitric, dil fzj. 

Tr. cardomomi comp f.^'j- 

Tr. gentian, comp. . . . . . q. s. f^ij. 

M. — S. Dessertspoonful every four hours. 

If the catarrhal state is persistent no remedy compares to the 
chloride of ammonium, dose 5 grains every four hours in liquorice 
and water. 

If the pills named do not control the diarrhoea the following may 
be used : 

$ . — Acid, sulph. aromat. ...... f^js 

Spt. chloroformi ....... 

Tr. opii camphorat . . . . . 

Syr. zingiberis . . . . . . q. s. 

M — S. Dessertspoonful every two hours. 

Or, 

R.— Tr. kino fgj. 

Tr. catechu comp. ...... f^j. 

Mistura cretas ....... f.^iij. 

Aq. cinnamomi . . . . . . q. s. fjjyi. 

M. — S. Shake well before using. Tablespoonful every three hours. 

In the second form of diarrhoea named, those in which serous or 
watery diarrhoea is present, the treatment is radically different. In 
these the bloodvessels of the gut are relaxed and leaking, and must 
be contracted and made water-tight. This dilatation may result from 
fear, " nervous diarrhoea," from exposure to cold, or from exhaustion, 
extreme heat, and irritant foods. If from irritant foods they are 
generally swept out in the first flush of liquid. 

The measures to be adopted consist in those directed to the con- 



398 DISEASES. 

traction of the dilated and relaxed bloodvessels, and the restoration 
of the proper nerve-supply to the parts. 

As the splanchnic nerves are the vaso-motor nerves of the intes- 
tine as well as the inhibitory nerves of peristalsis, it is evident that 
we must use drugs which will cause stimulation of these fibres, and 
the chief of these is found to be opium, which diminishes intestinal 
peristalsis and secretion by just such an influence. In the same way 
small doses of volatile oils are of service, and camphor and spirits 
of chloroform may be used. As there is relaxation, astringents are 
indicated, and as sulphuric acid is not only astringent but eliminated 
by the lower bowel, it is peculiarly serviceable. We find, therefore, 
that the following prescription fulfils every indication. 

R. — Acid, sulph. aromat. f^ss. 

01. cajuput. ....... gtt. xl. 

Ext. bsematoxylon ...... gij. 

Spt. chloroformi. ...... fgj. 

Syr. zinsjiberis . . . . . . q. s. f^iij. 

M. — S. Teaspoonful in water every three hours. 

If desired, kino or catechu may be used in lieu of the hsematoxylon, 
or oil of cloves substituted for that of cajuput. Camphor or pare- 
goric may also supplant these drugs. 

In some instances these attacks appear to depend upon hepatic 
disorder, and the only cure, aside from partial relief, is to be ob- 
tained by the use of mercury with chalk or calomel given in J to 
J grain doses. 

Wood has highly recommended the use of bismuth containing a 
drop or two of carbolic acid. 

The third class of cases seems in many instances to lie between 
those just spoken of and those in which the writer has placed them ; 
they occur chiefly in children and consist in the foetid " mousy " 
smelling stools of summer diarrhoea, with green spinach-like masses 
or distinct lientery. 

They may be due to deficient glandular action in any part of the 
alimentary canal, and are often cured by the use of pepsin and 
hydrochloric acid to perfect the gastric processes. In other instances 
the duodenum is at fault and should be excited by small doses of 
nitro-muriatic acid, or by podophylliu in the dose of -J-q to -^ of 
a grain with a little milk sugar, or given in solution. Similarly 
ipecac in powdered form may be used in the dose of \ to J a grain 
three times a day. As the child is often a sufferer from rickets, 
phosphate of sodium, lime salts, and common salt should be freely 
given. 

For the purpose of establishing intestinal antisepsis, carbolic acid 
may be used, and naphthalin, thymol, and other drugs of this class 
have been employed, particularly salicylic acid. None of them com- 
pare with carbolic acid, however, which should be used in 1 drop 
doses on bismuth or in water. 



DROPSY. 399 

Sometimes a good, brisk close of calomel followed by a saline does 
good in these cases, if they are strong enough to permit of its use. 

The regulation of the diet, which should consist in sterilized milk 
or koumyss, the former being precligested, is of the greatest impor- 
tance, and the proportions of the milk, water, and cream should be 
varied until a mixture is formed which is exactly fitted to the diges- 
tion of the case. The after-treatment consists in the use of tonics 
and a carefully regulated diet. 

The fourth type, generally known as dysentery, is due in some 
cases to hepatic trouble, in others in the drinking of impure water, 
and in the third place to exposure to heat and bad food. It is in 
most cases a very obstinate form of diarrhoea, requiring much skill 
and patience in its care. In the chronic forms deep ulcers may 
exist; in the milder cases a high inflammation is present. 

In those cases which are clue to exposure to heat and hepatic 
trouble there are two remedies which are far above all others in 
value and should always be resorted to. The first of these is ipecac, 
the second is calomel. 

The ipecac should be used in a special manner to be effective (see 
Ipecac, p. 191), and the calomel should be used in full purgative 
amounts, but is contra-indicated if much weakness is present. 

If the passages are slimy and bloody -j-j-^- of a grain of bichloride 
of mercury every hour or two is of service, or if much blood is 
present injections of the distilled extract of hamamelis are of value. 
In some forms of dysentery due to acute inflammation large enemata 
of iced water are of the greatest value. The water should be ice-cold 
and at least a quart injected by hydrostatic pressure. This method 
can only be used in strong persons. 

If the ulcers are very old and chronic, nitrate of silver injections 
may be employed in large bulk of the strength of 10 to 20 grains to 
the pint of water, a salt solution being at hand for its destruction if 
too great an action ensues. 



DROPSY. 

Dropsy is to be regarded as a symptom, not a disease in itself, and 
it may arise from many causes, such as cardiac, pulmonary or renal 
lesions, or depend upon obstruction to the normal flow of the blood 
and lymph through the tissues. Its existence is dependent upon so 
many causes of a still more indirect nature that it is almost impossible 
to notice all of them, but the following consideration of the subject 
will at least make clear some of the reasons for its occurrence and 
indicate the means which are to be taken for its relief. 

At the very start we are confronted by facts which seem para- 
doxical, but which are in reality quite reconcilable. These are that 



400 DISEASES. 

low arterial pressure predisposes to dropsy and that high venous 
pressure does likewise, or, in other words, that the cause of exuda- 
tion on one side of the circulation is its prevention on the other. 

The explanation of these statements lies in a thorough understand- 
ing of the physics of the circulatory system and its anatomical 
structure. It will be remembered that dropsical exudation takes 
place from the capillaries, and that the integrity of the walls of the 
bloodvessels and lymphatics depends upon normal nutrition or, in 
other words, from a proper blood supply. As a consequence dropsy 
may be due to poorly nourished vessels as much as to any other 
cause. Further than this a watery state of the blood permits ab- 
normal exudation. 

The force exercised upon the column of blood as it is driven out 
by the heart into the aorta may be considered as the chief support 
of the capillary circulation, so that if the heart be weak the pressure 
falls in the arteries and the rapidity of flow is decreased in the 
capillaries in consequence, while, on the other hand, an increased 
cardiac activity hastens the capillary circulation. As the arterial 
pressure and force depend not only upon the heart force but also 
upon the tonicity of the arteries which carry the stream, it becomes 
evident that dilated arteries must lower blood pressure even if the 
heart be strong, although practically the heart and vaso-motor system 
generally fail or increase in tone together. We find, therefore, that 
a weak heart or a relaxed artery both tend to cause stagnation of 
the blood in the capillaries, and having found that such stagnation 
is productive of exudation it is not hard to discover why low arterial 
pressure is a cause of dropsy. 

Having shown this to be true, let us turn to an explanation of the 
fact that a high pressure in the veins is productive of the same 
changes. 

Here the normal pressure is almost nothing, being much less than 
in the arteries, and considerably less than in the capillaries. The 
result of this is, that in health the blood flows rapidly from the high 
pressure of the artery to the low pressure of the vein, and passes 
through the small veins under a gradually decreasing pressure until 
it reaches the heart. Any obstruction to this venous flow must in- 
crease the venous pressure, and the venous pressure being increased 
the rapidity of flow through the capillaries must be decreased. The 
whole subject may be made more clear by the following example : 

Supposing that two iron tubes are connected at one end by several 
lines of rubber tubes (the capillaries), and that water is flowing into 
the iirst tube, or the artery, under a pressure which is represented by 
the figure 100, while the resistance to the flow in the second tube, 
the vein, is represented by the figure 0. It at once becomes evident 
that the rapidity of the flow through the connecting rubber tubes 
will be very great, whereas, if the pressure in the first or arterial 
tube is decreased to 50 the rapidity is decreased one-half, or if the 



DKOPSY. 401 

pressure in the second tube be increased to 50 instead of remaining 
at the same changes will occur, in either instance capillary flow is 
lessened and exudation is caused. This is the pathology of dropsy, 
and having understood it, let us proceed to discover the causes of 
dropsy in various diseases. 

In cardiac disease it is due to a weak heart being unable to supply 
the arteries with enough blood to maintain the normal pressure, or to a 
damming up of blood in the venous system as the result of the im- 
perfect emptying of the cardiac cavities. In the first instance low 
arterial pressure produces dropsy ; in the second, high venous pres- 
sure has a similar effect. 1 

In renal troubles the dropsy depends more upon the lack of proper 
nutritive processes in the capillary walls and upon changes in the 
blood pressure than upon other causes. If the kidney is diseased it 
may not be able to eliminate the proper quantity of liquids, which 
accumulate and finally escape into the tissues, while the same failure 
in renal function causes disease of the blood-paths themselves, and 
often produces cardiac complications. 

Hepatic troubles cause dropsy by producing pressure upon the 
large bloodvessels going to the liver, and in consequence, the exuda- 
tion is generally confined to the lower limbs and abdomen. If the 
hepatic trouble be severe, some failure in the nutrition of the blood- 
vessels and changes in the quality of the blood may ensue. 

Pulmonary disease rarely causes dropsy unless the venous pressure 
is greatly increased and productive of cardiac dilatation, or, as in 
phthisis, where the changes in the nutrition of the body involve the 
bloodvessel walls and the blood. 

Having spoken of these causes of dropsy it remains to consider 
its treatment, which may be divided into two parts, namely, that 
directed to its removal when once the liquid is poured out and its 
relief or cure by direct attention to its causes. The means for the 
removal of the fluid are suitable in all cases, be the cause what it 
may, unless the dropsy be of renal origin. Whenever an accumula- 
tion of liquid takes place in the tissues, drugs or measures must be 
resorted to which will cause the emunctories of the body to throw it 
off. In ascites, in particular, we may employ elaterium in the dose 
of -J- of a grain, or elaterin in the dose of ^ of a grain placed in the 
mouth and washed down by a little water, or if this is not used then 
compound jalap powder may be resorted to and given in the dose of 
20 to 30 grains, and to it may be added, to increase its efficiency, 10 
grains more of birtartrate of potassium than the officinal powder 
contains. These two remedies are particularly serviceable in renal 
dropsies since the elaterium is supposed to aid in the elimination of 
urea by the bowel, while the cream of tartar in the jalap powder 
increases the action of the kidneys. 

1 For an explanation of the changes in the action of the muscle, valves, and cardiac 
action in heart disease, see Heart Disease. 

26 



402 DISEASES. 

The cream of tartar is not to be used in acute nephritis. 

Compound extract of colocynth may be employed in the dose of 
2 to 6 grains, according to the state and idiosyncrasy of the patient. 

All these remedies relieve dropsy by causing so great an outpour- 
ing of liquid from the bloodvessels of the body that the liquids in 
the tissues are taken up by the depleted bloodvessels to replace the 
loss through the action of the purgative. 

In other words, these purgatives render the alkalinity of the blood 
greater by concentration, and absorption of fluid occurs by reason ot 
the following physiological and physical facts. 

As is well known to every physiologist, the passage of a salt solu- 
tion through a bloodvessel of less than seven-tenths of one per cent, 
causes an abstraction of salts by the circulatory fluid from the tissues, 
in order that the amount of salts in the vessels and tissues may be 
identical. At the same time the tissues become infiltrated with liquid. 
On the other hand, if the solution be stronger than the normal, the 
liquid leaves the tissues to enter the vessels and the tissues in conse- 
quence shrink. 

When salines are given to relieve dropsy they must be adminis- 
tered in concentrated solution and on an empty stomach, total absti- 
nence from the drinking of water being insisted upon until they 
have fully acted for the reasons given in the last paragraph. For 
this reason they should be given an hour or so before breakfast. If 
these directions are not followed this treatment is useless. 

The other means which we possess for the removal of dropsy are 
by way of the kidneys and skin. If the kidneys are hopelessly dis- 
eased this pathway is almost useless, but if they are only passive, or 
partly inactive, diuretics may be used to stimulate their secreting 
structure and to increase the leakage of liquid through them by in- 
creasing blood pressure. 

Often the kidney will be found inactive because, owing to its con- 
gestion from cardiac trouble, it cannot act. Under these circum- 
stances digitalis, in 5 or 10 drop doses of the tincture, given three 
times a day, will be of value, and its efficacy will be increased by 
the addition of 1 drop of the tincture of cantharides if the renal 
lesion is exceedingly chronic or mere torpidity exists. Digitalis and 
squill, in pill form, as follows, may be used. 



£ ._Pulv. digital, fol. ..... . 


. gr. xx. 


Pulv. scillse . 


. gr. xx. 


. ft. in pil. No. xx. — S. One every five hours. 





Or digitalis and calomel may be employed in pill form in renal and 
cardiac dropsies. 

Caffeine is also a useful diuretic, particularly in torpidity of the 
kidney, as it stimulates the secretory epithelium, thus eliminating 
urea and other effete matters, and increases the passage of liquids by 
increased blood pressure. 



DYSMENORRHEA. 403 

That a large amount of liquid may be gotten rid of through the 
skin under the influence of heat is well known. (See Heat.) In 
addition to external heat we may use pilocarpine by the mouth or 
hypodermically in localized dropsies, to produce absorption of liquid 
by sweating. No drug should ever be given hypodermically in 
dropsy of a general character as it will not be absorbed from the 
water-soaked tissues with any rapidity if at all. 

The muriate of pilocarpine may be given in the dose of ^ to J 
grain by the mouth, or ^ to J by the needle. This method of 
relieving dropsy is often very exhausting, and should not be used if 
cardiac depression or weakness is present. 

If dropsy depends upon deficient cardiac action digitalis will nearly 
always do good. (See Digitalis, page 148.) Or, if this is not used, 
citrate of caffeine will be found of service. 

Remembering that the dropsy is the result of failure on the part 
of the heart to do its work w T e must use proper exercise, food, stimu- 
lants, and rest, combined with fresh air and avoidance of mental 
worry. 

An infusion of scoparius, 1 ounce of the tops to a pint of water, 
taken in twenty-four hours, may be of service, and strophanthus, 
sparteine, and adonidin may all be used if any one of the drugs 
commonly employed fail. 

In hepatic cirrhosis, and in localized effusions of a chronic type, 
the best treatment for the removal of the liquid is the iodide of 
potassium, or tapping with a trocar and canula attached to an aspi- 
rating flask. 

Where the tenseness of the skin in the lower extremities causes 
danger of local sloughs some authors recommend small punctures 
for the escape of the liquid, the limbs being incased in sterilized 
absorbent cotton to absorb the liquid. 

Comparatively recently the use of saline purgatives (Epsom salts) 
has been largely resorted to for the relief of dropsy, owing to the 
study of Hay and others, who found that these drugs act by abstrac- 
tion of liquid from the tissues, when in concentrated form, as we have 
explained when speaking of the manner in which absorption takes 
place in dropsy. The manner of their administration must be careful. 
The solution of the sulphate of magnesium should be almost saturated 
and the dose be given on an empty stomach, preferably before break- 
fast. 

DYSENTERY. 

(See Diarrhoea.) 

DYSMENORRHEA. 

Dysmenorrhea rests upon so many conditions that the treatment 
of one of its forms in one instance seldom reaches success in the next 



404 DISEASES. 

case. This is not the place for a consideration of the surgical 
measures adopted for its cure, only the medical treatment being 
spoken of. 

Where dysmenorrhea results from the taking of a cold, and is 
accompanied by uterine congestion and irrritability, the following 
measures are particularly valuable and may do good in many other 
instances. The patient may take a hot sitz-bath and immediately 
get into bed as soon as the buttocks are dried, being well covered 
while in the tub, and afterward, by a blanket. A turpentine stupe 
is now to be used (see Turpentine), and 10 grains of Dover's powder 
to be administered, unless some idiosyncrasy toward opium is known 
to exist, when half or one- fourth of this amount may be employed. 
Often when the attack is accompanied by constipation, a purgative 
dose of Epsom salts or aloes is of service in these congestive forms. 

If the pain be persistently severe a belladonna suppository, of j- 
grain of the extract, may be inserted into the rectum, or in some cases 
belladonna ointment smeared over the os uteri will be found of ser- 
vice. The latter method is generally impractical and is rarely re- 
sorted to. Very commonly belladonna tincture, by the mouth, is ot 
service in relaxing the spasm of the cervix and of the uterine fundus. 

Some practitioners resort to the use of opium at each epoch, and 
keep the patient partially narcotized until menstruation is passed. 
This is unjustifiable and born of ignorance and bad practice, since 
the physician is simply dodging the trouble and predisposing the 
patient to future attacks, by reason of the constipation and resulting 
pelvic disturbances sure to appear after the employment of opiates. 

When the dysmenorrhea is due to obstruction of the cervical canal 
by organic changes or flexions, these conditions must of course be re- 
lieved before cure can be expected, and the medical treatment can 
only be directed to alleviation of the pain. Divulsions or slow or 
rapid cervical dilatation should be carried out through the use of 
instruments or tents. 

In neuralgic dysmenorrhea dependent rather upon nervous dis- 
order accompanying menstruation, than upon menstruation itself, 
measures directed to the improvement of the nervous system and the 
nutrition of the patient are necessary. These cases generally occur 
in nervous, anaemic women, ruu down by excessive dancing or other 
gaiety, or by the care and bearing of a large family of children. 

A course of strychnine or quinine in small dose and iron is often 
beneficial to these cases, and horseback exercise, between the periods, 
out-of-door life and avoidance of excessive dancing and exhausting 
exercise are to be ordered. 

Sometimes bathing the loins with alternate dashes of hot and cold 
water may do good in atonic patients. Cannabis indica and gel- 
semium, are often of great service, both as cures and alleviators of 
the pain, and antipyrine, acetanilide, and similar drugs may be re- 
sorted to while the attack lasts if it be neuralgic. 



DYSPNCEA. 405 

DYSPEPSIA. 

(See Indigestion.) 

DYSPNOEA. 

Shortness of breath or dyspnoea arises from cardiac weakness or 
palpitation, from the accumulation of fluids in the chest, the involve- 
ment of the lungs by any diseased process, in such a way that respi- 
ratiou becomes impaired, or indigestion, or finally by pressure upon 
the chest-walls by tumors and growths. 

Each of these states must be removed to effect a cure, but it is only 
of the relief of the symptoms that we will here speak. 

In old persons who suffer from dyspnoea, the result of bronchor- 
rhoea, where a large amount of liquid fills the bronchial tubes, 
and shortness of breath follows exertion, strychnine is the best 
remedy that we have. Its value depends upon its powerful influence 
over the respiratory centres, on which it acts as a stimulant, and as 
these cases also very commonly have dilatation of the right side of 
heart, with consequent cardiac enfeeblement, strychnine is of addi- 
tional service through its influence upon the circulation. These cases 
are not to be given opium, or its alkaloids, or any sedative drugs, as 
they give temporary relief from cough, but only serve to depress the 
respiratory apparatus and cause an accumulation of liquid mucus in 
the chest, as a result of the prevention of expectoration. The cases 
in which opium or morphine do good are those in which through 
nervousness or functional nervous disorder the respiratory cycle is 
imperfect, and, above all, in those instances where dyspnoea occurs as 
the result of cardiac disease. In these cases the attacks of oppression 
and suffocation can often be entirely set aside, by the use of J to J 
grain of morphine every night, or night and morning. If these 
doses fail, larger ones may be cautiously used. Hyoscine instead of 
giving sleep, nearly always makes these cases worse. 

Sometimes a little carbonate of ammonium is useful as a respira- 
tory and cardiac stimulant in cases of dyspnoea. 

l)ry cupping applied over the back of the chest may also be 
serviceable where shortness of breath from cardiac or pulmonary 
trouble is present. 

In the dyspnoea due to emphysema and pulmonary inflammation 
of a chrouic type, as is represented by those persons who take cold 
on the slightest cause, particularly after attacks of asthma, arsenic is 
useful if continuously employed. 



ECZEMA. 

This is probably the most common form of skin disease which the 
physician is called upon to treat, with the exception of acne. 



£06 DISEASES. 

Dermatologists divide it into many forms and stages, but in this 
place a consideration of its forms is out of place and the treatment 
for its stages is proper. 

At first it may be stated that the treatment is a quadruple one, 
namely, dietetic, hygienic, external, and internal. 

In regard to diet the patient should be told to avoid salt foods, 
such as salt fish or pork, and corned beef; greasy foods, such as bacon 
and fried dishes, pastry and cheese. Only moderate amounts of 
wine and beer can be taken, and viands difficult of digestion are to 
be striken off the bill of fare. 

In the way of hygienic measures, fresh air, the avoidance of seden- 
tary habits, horseback exercise, or walking is to be recommended. 
External treatment is the most important of the two measures in 
which drugs are employed, and its course is perhaps best described 
by taking a case of ordinary eczema, as an example, and treating it 
through its entire course. 

In the early stages of an acute eczema, when the process is very 
active and the erythematous reddening of the beginning of the 
disease is merging into the formation of vesicles or pustules, with 
the formation of large scabs, no application is better than oxide of 
zinc ointment thoroughly applied night and morning. If the eczema 
be situated upon the scalp the hair must be invariably clipped short 
or shaved off in such a way as to prevent the glueing of the hair 
into a mat by means of the discharge. The ointment may be smeared 
over the part or applied on a piece of lint in a thick layer. Nearly 
always the ointment should be used in conjunction with black wash 
(calomel 1 drachm, lime water 1 pint), which should be applied twice 
a day just before the zinc ointment is resorted to, by means of a swab 
or soap and allowed to dry. In other cases the powdered oxide of 
zinc is dusted over the part if the discharge is very watery and pro- 
fuse, or the following ointment, recommended by McCall Anderson, 
is very efficacious : 

R. — Bismuth, oxidi 

Acid, oleic, pur. . 
Cerse albse 
Vaselin 
Olei rosae 

M. ft. in ung. — S. Apply to the part affected. 

As the quantities of this prescription are large they may be re- 
duced one-half for use in limited eczema. 

Where the proliferation of cells and the secretion are very profuse 
it may become necessary to remove the crusts before the local reme- 
dies can reach the skin, and for this purpose poultices may be used ; 
or, if the disease be on the face, the parts should be anointed with 
olive oil, containing 1 or 2 drops of carbolic acid to the ounce, to 
soften the crusts which are readily removed in a half hour by the 
use of a little castile soap and water. The soap is not to be used if 



ECZEMA. 407 

the inflammatory action is very angry looking. Whenever itching 
is an annoying factor the parts should be protected by lint smeared 
with ointment to prevent itching, and a little carbolic acid employed 
in each application for its local anaesthetic effect. English and 
American dermatologists use what is known as liquor carbonis 
detergens very largely in the acute stages of eczema as well as in 
other skin diseases. It should not be used pure, but diluted in such a 
way that for each 4 ounces of water 2 drachms of the pure liquor 
are present. Liquor carbonis detergens is made by taking 9 ounces 
of tincture of soap bark (quillaia bark) and 4 ounces of coal tar, 
mixing and allowing them to digest for eight days, after which the 
mixture is filtered and used. 

When the disease has passed from the acute, active inflammation 
of the first stage to the subacute form of the second stage of its ex- 
istence applications of a mildly stimulant character are necessary. 
Before this the physician has endeavored to soothe the parts; now they 
must be excited to normal activity. For this purpose resorcin in 
the proportion of 2 to 30 grains to the ounce, according to the se- 
verity and induration of the lesion in the skin should be used. 
Stelwagon recommends the following : 

Be. — Unguent, picis. liq ^j. 

Unguent, zinci oxidi ...... ,^vij. 

M. — S. Apply to the parts. 

Where the disease is absolutely chronic and very persistent, but 
sluggish or atonic in its course, still more powerful remedies are 
necessary, such as salicylic acid, tar, or tincture of green soap used 
with hot water until the skin beneath is bared, dressing this by 
means of zinc ointment or resorcin ointment, 2 to 10 grains to the 
ounce, spread on a cloth. The salicylic acid should be used in the 
proportion of 30 to 60 grains to the ounce of lard, while the tar is 
used in the form of the pure officinal tar ointment. 

Internal treatment is directed to the cure of any disordered 
function which is present, such as dyspepsia (see Indigestion), 
hepatic torpor, general debility, anaemia, scrofulosis, inanition, con- 
stipation, gouty diathesis, or renal insufficiency. The gastric disorder 
is to be treated by the use of hydrochloric acid and pepsin; the 
hepatic torpor by mercury, podophyllin, or, better still, nitro-hydro- 
chloric acid, of a dark-red color, not orange color; the debility by 
tonics, such as cinchona, cod-liver oil, strychnine, and bitters ; the 
anaemia by iron, and, if scrofulosis exists, by the syrup of the iodide 
of iron. Constipation is to be cured by the use of proper foods and 
laxatives, and the gouty tendency counteracted by the use of lithium 
citrate and colchicum, or potassium iodide. If the kidneys are at 
fault the diuretic potassium salts, such as the citrate, are indicated. 
Arsenic is never to be used, except in a few instances where the skin 
is very dry, and where, by improving digestion and its alterative 



408 DISEASES. 

power, it does good in the chronic forms or those depending upon 
some atonic state of the trophic nerves of the skin. 



EMISSIONS. 

Seminal emissions occur as the result of sexual abuse, whereby a 
condition of hyper-excitation of the nervous cells in the spinal cord 
and the nerves of the genitalia is developed, or they are due to 
peripheral or centric irritations, which reflexly irritate the genitalia 
or their nerves, and to a number of other similar causes. These 
emissions also occur with some periodicity in normal males, who are 
continent and chaste, and, under these circumstances, are not to be 
interfered with by treatment, unless they become excessive. 

The former types are, however, proper for medical treatment, and 
their cure consists in the avoidance of unchaste literature and 
thoughts during the waking hours, and the use of such spinal and 
cerebral sedatives that the centres governing the ejaculations of 
semen may be quieted, and so quiet a sleep produced that lascivious 
dreams are avoided. The patient should sleep on a hard hair mat- 
tress, and not be too heavily covered, and should avoid sleeping on his 
back, as this causes an undue blood-supply to the spinal centres, and 
consequent stimulation and ejaculations. Sometimes hard bodies, 
such as spools, are tied around the loins so that any change of posi- 
tion will cause so much discomfort that the patient awakes and turns 
on his side. The drugs to be used are bromide of potassium or sodium 
in 20 grain doses, at bed-time, or chloral may be taken in the same 
amount. Hyoscine has been most enthusiastically recommended by 
Wood in the dose of yJ-Q- grain. Sometimes a warm sitz bath or 
general bath, before going to bed, is of service. 

In the cases of emissions which come on as the result of conti- 
nence, and which become excessive, these remedies are to be tried, 
but really do not effect any permanent cure unless used until sexual 
power is seriously depressed, and it has been the custom of many 
physicians to recommend " marriage/' which the patient may inter- 
pret in its legitimate light or not, as he pleases. 

It is worthy of note that all irritations of the urinary bladder 
and other parts 'of the genito-urinary system should be removed, and 
it is often of value to administer citrate of potassium in 20 grain doses, 
in water, three times a day, to render the urine non-irritating and 
alkaline. Stimulating foods and drinks are to be interdicted, and 
condiments, such as pepper and mustard, avoided. 

Sometimes, where the condition rests on genital atony, strychnine 
and arsenic are of very great service if given in full dose. 



EPILEPSY. 409 



ENDOCARDITIS. 



Endocarditis occurs sometimes as a single manifestation of disease ; 
sometimes as a symptom, with many others, of some general ten- 
dency, produced by a diathesis, such as gout and rheumatism, or 
syphilis. Further than this, it may be acute, subacute, or chronic, 
and each one of its forms must be differently treated. 

It is hardly necessary to state that any diathetic taint should be 
treated by anti-rheumatic or anti-lithic remedies, or the iodides. The 
iodides are not, however, indicated if any rapid changes of a degen- 
erative type are at work. In acute sthenic eudocarditis, associated 
with great vascular disturbance and much cardiac embarrassment, or 
irregularity, there is no remedy in the early stages half so good as 
full doses of tincture of aconite, 2 to 8 drops, given every hour until 
the physiological symptoms of its influence are felt, or, in its place, 
with equal efficacy, may be employed the tincture of veratrum viride 
(2 to 3 drops). At the same time calomel and opium may be used ; 
the calomel, for its antiphlogistic influence, and the opium, to control 
the purgative tendencies of the mercurial. Thus we may use J grain 
of calomel every two hours and -^ of morphine. Leeches should 
be placed over the prsecordium in goodly number, and if these are 
not obtainable wet cups are to be employed. This depletion is only 
of service when the disease is seen early enough to make its abortion 
possible. As the disease progresses, if the physician fails to stop it, 
it will be found that the heart becomes somewhat labored, irregular, 
and weak, and that its rhythm is seriously interfered with. At this 
time digitalis is of use in stimulating the depressed cardiac muscle and 
increasing its reflex activity and also steadies it through the pneumo- 
gastric irritation which it sets up. Aconite and other depressants 
are contra-indicated at this time. Absolute rest is to be insisted 
upon, and it is recommended, in these cases where deposits of a cal- 
careous nature are likely to occur in the valve, that the citrate or 
acetate of potassium be given, or that citrate of lithium be employed. 
If the disease becomes purulent, or rather ulcerative, supportive 
treatment, consisting chiefly in the use of good food, and the ad- 
ministration of the tincture of the chloride of iron is of great value 
if the dose be lar^e. 



EPILEPSY. 

The disease known as epilepsy is probably the most disheartening 
condition as to treatment that the physician has to deal with, since 
it often resists the influences of all the standard remedies, and drives 
the practitioner from drug to drug in the hope of finding one which 



410 DISEASES. 

is at least alleviating in its effects. For this reason the author has 
in this instance included the drugs which are rarely used, as well as 
those recognized for treatment, in order that the physician may try 
every remedy of any possible value. 

It should be borne in mind that the treatment of epilepsy is as 
various as the disease is variable in its forms and phases, and should, 
in nearly all cases, resolve itself into two or perhaps three divisions, 
consisting in the removal of any exciting cause, in the checking of 
the convulsive tendency already set up, and in the prevention of any 
further attacks by suitable drugs or other measures of relief. 

The treatment is governed largely by the cause, and is medicinal 
or operative, according to the etiological factors at work. In the 
simple idiopathic epilepsy medicinal means must be followed, while 
in a case resulting from traumatism the depressed bone, abscess or 
tumor must be removed, and in those due to reflex irritation, the 
peripheral source of trouble must be sought out and relieved. 

So far as drugs are concerned, the most valuable remedy in use, 
for relief of epilepsy is bromide of potassium, although other forms 
of bromide salts are to be mentioned later on. 

This drug, however, is not a " cure-all, " even in epilepsy, and re- 
ports are constantly made of cases where it has failed ; but many 
cases prove that the remedy is undoubtedly responsible for a cure 
when it is pushed in a suitable mauner, and, in the vast majority of 
instances, the seizures are so decreased, both in violence and frequency, 
that its use may be said to be indicated in every case of the disease. 

In a very small minority, however, it signally fails ; and, in a still 
smaller number of cases, it is useless, unless combined with some 
other drug whose power alone is very slight. Nevertheless it is to 
be laid down as a rule, that the bromide treatment of epilepsy is, par 
excellence, the treatment to be employed on every occasion. There 
is no other drug known which can be relied upon so absolutely, or 
which is so powerful in its action and devoid of marked toxic effect, 
unless given in enormous doses. 

The doses to be used vary with the salt employed to a considerable 
extent, and depend upon the character of the disease and the temper- 
ament and physique of the patient. The greater the duration of 
epilepsy is, the greater the difficulty exists in effecting a cure; and the 
length of time which the man has been epileptic should therefore be 
most carefully reckoned before the treatment begins. Further than 
this, the frequency and severity of the attacks are to be looked into, 
and these points are really more important than the actual duration 
of the ailment ; since, if a man has only one fit every six months for 
twenty years, his condition is far less serious than if he has a history 
of three or four fits a day for one year. Again the character of the 
attack, as to its violence, may be the most important fact to be re- 
garded ; for, if they are violent enough when they come on to en- 
danger life, remedies must be pushed even beyond the point of toler- 



EPILEPSY. 411 

ance. The writer has heard a very celebrated physician cause much 
amusement among his auditors, by detailing an instance of an epileptic 
who was getting well, and would have recovered if he had not died. 
His explanation was, that the man was syphilitic, and was receiving 
moderate doses of iodide of potassium, which were slowly benefiting 
him, and would have cured him had not a single severe fit produced 
death in the meanwhile. Another point to be calculated upon is the 
condition of the digestion, which the bromide of potassium is pecu- 
liarly liable to disorder, and which is sometimes so troublesome as to 
necessitate the administration of the drug by the rectum in serious 
cases. Females generally require smaller doses than males, and 
children of both sexes do not require as large quantities as adults. 
The dose, to be used in the beginning of the treatment, in moderate 
cases, is about 10 grains thrice a day ; and while this may seem a 
very small quantity, it will be found that it can be rapidly increased 
in amount without causing the gastric distress produced by the sudden 
use of larger doses. Every day may have an additional ten grains 
added until at the end of a week, the patient is taking 80 grains in 
each twenty-four hours. There are very few cases which will not 
become completely saturated by the drug if this is done, and there 
are very few in which a more rapid arrival at bromism is needed. 
If, however, the patient has become able to stand large amounts, by 
the prolonged use of the drug, the amount given is not to be governed 
by grains but physiological effects, and it may be pushed almost to 
any amount which is borne. 

In chronic epilepsy, too, with regularly occurring fits, the greatest 
good is obtained by pushing the drug in ascending doses for one 
week, and then, for the succeeding week, only enough is given to 
preserve the general effects of the medicament. By doing this the 
stomach gets a rest and the appetite is not so interfered with. Where 
the attacks occur only every two weeks, this is a particularly useful 
method for obvious reasons. As regards the time of day when the 
drug is to be taken, there can be no doubt. Some writers have di- 
rected that it shall be taken always before meals ; but this is entirely 
lacking in. advantage and decidedly fruitful of harm. Medicines 
which are given so as to affect the general system should be taken after 
meals, not before, and it is only when a local gastric effect is desired 
that we use them on an empty stomach, particularly when the sub- 
stance is as irritant and depressing as potassium. If taken after meals 
the appetite is not decreased, but there are few who can take a dose 
of 10 or 20 grains of bromide of potassium before breakfast without 
suffering from indigestion. It has been held by some that the drug 
should be taken in minute doses, frequently repeated, in order to 
keep the patient constantly under its influence. This is an example 
of therapeutic ignorance, which will be explained when the elimina- 
tion of the bromide is spoken of, and possesses the disadvantages of 
being inconvenient, annoying, and apt to disorder the stomach. 



412 DISEASES. 

If the attacks have a distinct periodicity, or can be foretold, for as 
much as two hours beforehand, the remedy may ouly be taken in a 
large dose at this time, and but a few grains given in the intervals, 
and if these attacks are severe, no one should hesitate to use large 
doses, by the mouth, and by the rectum on the day of the attack. 

A very important point to be borne in mind, is that the drug often 
seems to have produced a complete cure, and this results in careless- 
ness in the regularity of administration. The patient should be im- 
pressed by the fact that every day passed without a fit is a step for- 
ward, and that every fit carries him many steps backward. He 
should also be made to use the drug in moderation, for at least three 
years after all fits have ceased, and to watch, after that time, for the 
slightest sign of their return. The quantity taken each day should 
be gradually decreased, not suddenly stopped short. 

It is true, also, that if a recurrence of the fits takes place they yield 
to treatment very much more slowly than before. 

Before passing on to the discussion of the other bromides, and the 
conditions produced by the excessive use of all of them, we may 
place our use of these compounds in epilepsy on a scientific footing. 
It is now gradually recognized that the seizures known as epilepsy 
are cortical in origin, and there can be no doubt that the bromides 
act very powerfully upon the cerebrum in the higher animals, de- 
creasing the irritability of the motor centres in these regions to a very 
great extent. Not only is this pointed to by a clinical fact, but the 
well-known researches of Albeftoni seem to prove that such is their 
action beyond all doubt. This investigator found that the adminis- 
tration of a single dose of the bromide of potassium so lessened the 
excitability of the motor-cells in the cortex cerebri, that much stronger 
stimulation was necessary, in order to cause response in the limbs, 
than was normal, and that it was difficult to produce epileptic at- 
tacks, by means of the electrical stimulation of the areas, even when 
currents were used very much stronger than those which commonly 
produce such a result. He also found that this lessened irritability 
was increased still further if the drug was given for several days be- 
forehand in such doses as thoroughly to impress the organism. It is 
therefore evident that the bromides act directly on the cortical areas, 
calming the tendency to explosions of nerve force. 

The results of Seppilli have also confirmed those of Albertoni in 
every w 7 ay. 

An enormous amount of research has proved also that the drug 
may be doubly useful in reflex epilepsies, not only by its action on 
the motor cortex, but by its influence on the afferent portion of the 
nervous system. 

The experiments of Eulenberg and Guttman prove that the 
sensory paths in the spiual cord feel more powerfully than any other 
portion of the body the effects of the drug ; for these investigators 
found that if they tied the bloodvessels, supplying one limb of an 



EPILEPSY. 413 

animal, reflex action was abolished equally on both sides, proving 
that the loss of reflex action does not depend upon the action of the 
drug on the sensory nerve-trunks. That the loss of reflex is not due 
to an action on the motor portion of the cord is proved by the fact 
that voluntary motion is completely preserved. As these experi- 
ments have been confirmed by Lewisky, Bartholow, Purser, the 
author, and Laborde, there can be no doubt of their truth ; and we 
can rest assured that not only does the drug prevent nervous dis 
turbance in the cerebrum, but that it also prevents the peripheral 
irritation from travelling up to the brain, there to produce morbid 
excitement. 

Apropos of the theory that epilepsy is due to vaso-motor disturb- 
ance, which is unfounded, it may also be added that the bromide of 
potassium was, and is, believed by some to effect a cure by produc- 
ing a vaso-motor spasm at the base of the braiu, but there is not one 
atom of reason in this idea, even if the disease were due to vaso- 
motor changes. Hammond and Amory have seen the circulation in 
the brain slowed by the drug, and it has been claimed by Lewisky 
that if the toes be cut off the blood flows more slowly from them in 
the poisoned animal than in the normal frog. None of these facts 
prove vaso-motor action, but rather that there is a lessened circula- 
tion by reason of cardiac depression produced by the potassium, 
which is well known to occur. 

An important therapeutic point is to know how rapidly bromide 
of potassium is eliminated, so that we may know how frequently to 
give the drug. 

That it is passed out with only moderate speed is certain, for 
Rabuteau has noted its presence in the urine one month after the 
last dose, and Bill had found it two weeks after the use of the drug 
had ceased. 

Amory recovered, on the other hand, one-half the amount ingested 
in the first succeeding twenty-four hours, and one-third in the second 
twenty-four hours. It is evident, however, that it is eliminated so 
slowly that doses given three times a day make the patient ingest 
more than he passes out. That it remains long in the system is 
proved by the fact that after repeated doses given to a healthy man 
marked somnolence persists for some days. 

There is one more point to which attention must be called, and 
that is the fact that when the bromides are taken for any length of 
time they produce bromism which, in its moderate or severe forms, 
produces a mental condition very closely allied to that seen in old, 
chronic epileptics. This condition of the mind should never be 
overlooked ; and the mental changes of epilepsy are greatly increased 
by its constant and careless administration. 

The bromide salts of iron, sodium, lithium, nickel, and ammonium 
have all been used in epilepsy with good results; but, except in 
certain instances, they fail to act as well as that of potassium, unless 



414 DISEASES. 

given in larger doses. There are several occasions in which, how- 
ever, each one possesses marked advantages, and may succeed where 
potassium has failed. In all cases of epilepsy complicated with 
anaemia the bromide of iron should be employed ; but where there 
is plethora it will generally increase the disease or do no good. 
Where it acts after potassium fails, the iron is of value, because of its 
tonic and nutritive effect. Bromide of sodium, while somewhat less 
powerful than potassium is not by any means so apt to disorder the 
stomach, and is preferable in some cases on this account. It pos- 
sesses no other advantages. 

The bromide of lithium has been highly recommended in intract- 
able cases by Weir Mitchell, who even states that it may be given 
in one-half the dose of the potassium salt with equally good effects. 

The bromide of nickel cures some cases where all other remedies 
fail, but this is rare. In a series of physiological experiments made 
by the writer some years since, he found it virtually identical with 
the potassium salt in its action, and it is useful in about the same doses 
and cases as bromide of potassium. 

The bromide of ammonium is very irritant and disorders the 
stomach quite readily. It ought always to be used, when used at 
all, with some other drugs, the ammonium only acting as an 
adjuvant. 

Several authors have tried hydrobromic acid, but it is very much 
more apt to derange digestion and to produce vomiting than any of 
the salts. The dose of the dilute acid is J to 1 ounce in a tumbler- 
ful of sweetened water. 

The bromate of potassium has been used by Mitchell in not more 
than 5 to 10 grain doses with good results, but is more dangerous 
and scarcely of greater value. 

There can be no doubt that in some instances what is known as 
the mixed treatment is successful when all else fails. This consists 
most commonly of a prescription in which the bromide of potassium, 
sodium, and ammonium take part. Why this combination acts 
better than any one of the salts alone no one knows, but it is 
certainly a clinical fact. 

In other cases still, digitalis when used along with one of the 
bromides seems to attain favorable results. Indeed, digitalis has 
for years been used alone in epilepsy with fairly good results, and 
should always be used in obstinate cases. In petit mal, where bro- 
mide of potassium alone so often fails, it is useful, and several Eng- 
lish writers, notably Gowers, assert that its best effects are in cases 
of nocturnal epilepsy. Why this should be the case no one knows, 
and it would seem doubtful whether it does any more good in noc- 
turnal attacks than in others. Indeed, it is difficult to understand 
how it can influence epilepsy at all, for its action on the nervous 
system is slight, save in toxic amounts, when it lessens reflex action 
very markedly, first by stimulation of Setschenow's reflex inhibitory 



EPILEPSY. 415 

centre, and later by paralysis of the spinal cord. This latter action 
never occurs, of course, in its medicinal use ; but in medicinal doses 
it may, by acting on the inhibitory centre, allay convulsive tenden- 
cies. Probably its chief action is through its circulatory effects, and 
further study may show it to be efficacious only in those cases where 
a heart tonic is required. 

Another combination very much employed and lauded is bromide 
with belladonna, the mydriatic being alone almost useless, but of 
great antiquity in its use in epilepsy. Like the mixture of digitalis 
and bromide it suceeeds very frequently in petit mat, and indeed seems 
to be much more successful than the digitalis, but its mode of action 
is exceedingly doubtful. As the drug acts even more powerfully 
upon the nervous system than the circulatory apparatus, it has been 
thought that its influence for good depended upon this effect, but the 
experiments of Seppilli contradict this belief, for he found that it 
atropine was given to an animal the surface of the cortex cerebri 
responded more readily than is normal to stimulation. 

At one time it was held that belladonna acted on the spinal cord 
aud peripheral nerves under such circumstances, but it should be re- 
membered that we now kuow that atropine is only of value in relax- 
ing spasm when given in full dose, oftentimes hypodermically, and 
that Albertoni has made a series of experiments to determine whether 
it irritates the motor centres of the cortex. In his hands repeated 
small doses or one large dose in no way retards the convulsions pro- 
duced by stimulation of the brain. Both these investigators are, 
therefore, in accord. 

Under these circumstances it affects rather the motor nerve end- 
ings than the central nervous apparatus. At the present time those 
who believe the origin of epilepsy to be dependent on cerebral vaso- 
motor spasm rest the occasional good results from the use of this drug 
on its vaso-motor influence, but there is a good reason for throwing 
this idea aside, even if the morbid process named was really present, 
namely, that the drug in ordinary medicinal doses raises arterial 
tension by stimulation of the vaso-motor centre, while it only lowers 
blood pressure when given in toxic amounts, and then by an action 
on the bloodvessel walls. 

As long ago as the early part of this century cannabis indica came 
into notice in the treatment of epilepsy, and is probably of greater 
value alone than when combined with any other drug, unless it be 
the bromides. Although it is at present rarely so used, the author 
believes from his own studies that it is of value ; for he found that 
it distinctly lessens reflex action and acts powerfully upon the higher 
nervous centres in the brain. Its use and value in migraine are un- 
deniably of the greatest importance, and epilepsy and migraine are 
often very closely allied. 

G-elsemium sempervirens is an American plant whose praises have 
been widely heard in almost every disease. Its influence alone is 



416 DISEASES. 

worthless, for it possesses no power over the cerebral centres what- 
ever ; but, in combination with caunabis indica it makes a very 
useful agent, and depresses the conducting power of the spinal cord, 
while the cannabis indica in its turn quiets the cerebrum. The dose 
of the tincture is 20 drops, but it should be remembered that it is as 
poisonous as the other is innocuous. 

Owing to the soporific influences exercised by opium it has been 
very frequently tried, with success and failure as a result. It 
certainly has not taken any rank in the list of remedies, and is 
deservedly lacking in professional favor. It increases reflex activity 
very commonly and seems to affect the intellectual areas of the 
cerebrum rather than the motor portions, although Seppilli's ex- 
periments show it to exercise a decided depressant influence over 
these areas. Combined with gelsemium it may perhaps be employed, 
but only when nothing else is at hand, or all other remedies have 
failed. If it is so employed great care is to be used, and it should 
not be forgotten that both drugs kill by respiratory failure. When 
used in "status epilepticus'' it often does good in relieving the 
spasm, but it must be employed in large doses, and if the succeeding 
coma of epilepsy has added to it that of large doses of opium death 
may ensue. 

The employment of zinc, in its various salts, has been greatly 
recommended for many years, but has found little favor of late 
among the profession. 

It has been stated that it quiets the cerebral cortex, the medulla 
oblongata, and spinal cord, and, in this way, cures the attacks. This 
is, however, merely clinical evidence, and has no experimental proof 
to support it. Even its most sanguine supporters confess that its 
range of usefulness is generally in those cases where the bromides 
succeed, and agree that its powers are much inferior to these com- 
pounds. The dose of the oxide is 3 to 7 grains twice or thrice a day, 
and even in this amount it may cause nausea and vomiting. The 
citrate is more soluble, and is better borne by the digestive apparatus. 
Its influence over the disease is probably the same, as is also true of 
the lactate, which was so largely used by Herpin, and which is the 
best salt of zinc to use. 

Nitrate of silver was brought into use long before the value of 
more recent drugs was known. Every one is agreed that it lacks all 
power for good, save when it was used constantly for a long time. 
As the drug is eliminated very slowly it rapidly accumulates, and 
argyria soon comes on. It may be used after all else fails in doses 
of J to J grain thrice a day after meals, the mucous membrane of 
the inside of the lips, and the conjunctiva, being carefully watched 
for the early signs of chronic silver poisoning. We certainly have 
no knowledge as to its influence on the nervous system ; and, if it 
acts at all, it must be by some alterative influences rather than by 
any other means. 



EPILEPSY. 417 

Nitroglycerin is to be employed rather in petit mat than liaut mal y 
in the dose of 1 drop of a one per cent, solution, once, twice, or 
three times a day. Our knowledge of its effects, so far as its cura- 
tive influences are concerned, is very slight, but it really seems to 
benefit some cases. Its action is very, fleeting, and it influences the 
brain very little, except it be taken just before an attack is expected, 
or where the cardiac action is defective. Its great lethal power 
should never be forgotten. 

The use of the nitrite of anryl is not for the purpose of directly 
curing the disease, but of warding off impending attacks, the warn- 
ing of which is given by an aura of slow progression. It increases 
the severity of petit mat, but in epileptics who have a prolonged aura 
we may use nitrite of amyl pearls, which consist in small glass bulbs 
containing a few drops of the drug. As the aura comes on, the 
patient should break one of these in his handkerchief and inhale the 
drug, thereby putting aside the attack. The influence which the 
drug exerts upon the brain is secondary rather than primary, and is 
probably dependent on its action on the blood or circulation. Its 
influence on the spinal cord and nerves is much more marked and 
direct, and it is most certainly a very powerful spinal depressant. 
As its influence over unstriated muscular fibre is very great it affects 
the vaso-motor system very powerfully ; and those who think that 
epilepsy is due to vaso-motor spasm at the base of the brain point 
to the effects of this drug as a proof of their hypothesis. Such 
reasoning is not, however, necessarily correct. Nitrite of amyl puts 
aside an attack by a sudden shock to the nerve centres, which diverts 
them, so to speak, from their intended discharge, very much as a 
ligature around the arm stops an aura. Wheu we remember that 
the drug acts instantly and converts nearly all the oxygenating blood 
of the body into a non-oxygen-carrying fluid, by reason of the 
nitrite-oxy-hsemoglobin produced, the sudden change in the cerebral 
nutrition and state is most marked. 

In the " status epilepticus" it is of great value in stopping the 
seizures, and may be used under these circumstances in heroic 
amounts, applied at intervals to the nostrils. In the tonic spasm, if 
it be severe enough to stop respiration, it should be remembered that 
as the drug is not inhaled it is absolutely worthless. It is only when 
a moment of relaxation occurs that it does its work. 

As a general rule, the nitrite of ammonium or sodium, which are 
prolonged in their effects, should be used to supplement the amyl 
salt. 

Gowers states that nitrite of amyl does good in epilepsy by flooding 
the brain with arterial blood. How such a statement can be made 
by anyone is amazing. Of all the drugs in the world nitrite of amyl 
produces exactly the opposite change, as Gowers should be aware, 
from his own use of the substance. 

The use of anaesthetics in epilepsy is virtually useless, and, in 

27 



418 DISEASES. 

some cases, dangerous, for ether is too slow in its effects and ma}', by 
its irritant vapors, increase the tendency to laryngeal spasm or cause 
lung complications. Further than this, if ursemia is the cause of 
the fit, and this fact is unknown in every case until it is carefully ex- 
amined, the ether may increase the inflammation of the kidneys very 
seriously. 

Chloroform, though it acts much more rapidly, may cause sudden 
cardiac failure, and both drugs may increase the post-convulsive 
coma very greatly. 

In "status epilepticus" they may be used, as in such cases the 
convulsions must be stopped at all hazards, although the preference 
should always be for amyl nitrite. 

The iodide of potassium is entirely useless in epilepsy unless it is 
due to syphilis, when it is of the greatest service. Indeed, the bro- 
mide and all other drugs should be set aside while it is pushed to the 
utmost. As is well known, syphilitics usually bear the drug ex- 
tremely well ; and the author knows of one instance where no less 
than 800 grains were taken every twenty-four hours with rapid im- 
provement as a result. This point is strongly insisted upon by all 
therapeutists and syphilographers, notable among whom stands 
Fournier. 

Where the convulsions are due to a gumma the iodide of potassium 
is, however, too slow in its action and should be replaced by mer- 
cury in order to break down the growth without delay, lest a seizure 
end the scene by asphyxia or some similar accident. 

Some difference of opinion exists as to the usefulness of iron in 
epilepsy. Several very eminent clinicians have asserted that it 
always makes the attack worse and, therefore, does more harm than 
good. Like everything else, iron is no more to be giveu in every 
case than is a dose of oil ; when there is plethora it is harmful, and 
when there is malnutrition and ausemia it does good. Over the 
disease itself it has really no effect at all, except through its action 
on the general system. 

Chloral hydrate is a remedy which has been only partly tried in 
epilepsy, and its usefulness is not as yet determined. It possesses 
the marked disadvantage, as compared to the bromides, of being a 
very fatal poison, which is an important fact to be borne in mind by 
the physician, when giving it to the patient, whose mind, already 
weakened by the disease, or naturally stupid, may forget and take 
too much. Its physiological action indicates much more fully than 
many other much more lauded remedies that it may be of value, 
since it exerts its chief influence on the motor pathways of the spinal 
cord and quiets the motor portion of the cerebral cortex and also 
produces sleep. Seppilli has proved this, by direct experimenta- 
tion after the method employed by Albertoni. Its use, combined 
with one of the bromides, is often accompanied by the most desirable 
results, and should be tried at all times unless some cardiac compli- 



EPILEPSY. 419 

cation forbids it. It may disorder the stomach, and should, like the 
bromides, always be given well diluted and after meals. 

Of the more recent remedies acetanilide certainly stands in the 
foremost rank, and bids fair, in some instances to rival the bromides. 
Professor Germain S6e, myself, and some others have reported cases 
which obtained very marked relief from it, and more recent investi- 
gators have clone likewise. The drug will be found to exert its chief 
benefits in chronic epilepsy. At least, if a child was brought to the 
author with a beginning epilepsy, he would use the bromides, but, if 
the disease was chronic, acetanilide. 

Antipyrine has also been pushed forward as a remedy, and as the 
physiological action on the nervous system is virtually identical with 
acetanilide, the writer will speak of them together. 

Antipyrine has been recommended by Lemoine in certain forms of 
epilepsy, but condemned in most cases. In those who suffer from 
menstrual epilepsy, so-called, or in those in whom the attack is pro- 
duced reflexly by the presence of intestinal parasites the drug does 
good. 

Lemoine also found it very useful in those cases associated with 
migraine. In these cases the results were better than with the bro- 
mides, but in the idiopathic, simple varieties it was useless. Mairet 
and Combemale have used the drug in epileptiform mania with 
satisfactory results. 

In children suffering from frequently recurring epileptic attacks 
the presence of worms should always be looked for, and when found 
should be expelled as rapidly as possible. If they are the oxyuris 
vermicularis (seat worms) the best remedy by far is the injection of 
a strong infusion of quassia of such a strength that there are 2 ounces 
of quassia to each ounce of water. 

In girls, where the removal of the worms from the rectum is not 
followed by relief, a careful examination of the vagina should be 
made and quassia employed in somewhat weaker solution, as very 
commonly intense inflammation is there present, produced by migra- 
tory movements of rectal parasites. If the quassia is unobtainable 
in any case, a saturated solution of chloride of sodium may be 
employed. 

The treatment of epilepsy by borax has not received very wide 
recognition. Perhaps the most thorough studies of its effects have 
been those of Gowers in England, and Folsom in America. It 
would seem that some cases which are obstinate, under ordinary 
treatment, are benefited by it, but it certainly is not to be commonly 
employed. The dose generally given is about 15 grains. 

Having spoken of the drugs which may be given to epileptics, 
attention may be drawn to those which may not be used. There is 
a very large amount of reliable evidence, both experimental and 
clinical, that quinine should never be employed where it can be 
avoided. Thus Seppilli, in his researches, found that it increased 



420 DISEASES. 

the irritability of the cerebral cortex, and Briquet has asserted that 
it is a direct cerebral stimulant. That toxic doses of quinine may 
provoke epileptiform convulsions has been proved by Jakowbowich, 
who has seen them in dogs and in other animals, aud Brown-Sequard 
and Albertoni have noted that cinchouidine and quinine always 
increase the number of attacks in epileptics. 

Salicylic acid, too, has an effect upon the brain very closely allied 
to that of quinine, and should always be used with care in epilepsy. 
Prof Germain See has also pointed out that large doses of this 
drug produce violent epileptiform convulsions in the lower animals. 

Strychnine, while its chief effect is to heighten the activity of the 
spinal cord, also, according to Seppilli, increases the irritability of 
the cortex and should be employed only in particular cases. The 
same writer also found that absinthe and picrotoxin predisposed to 
epileptic seizure by increasing the excitability of the motor zone. 

Bleeding the patient in epilepsy, unless there is great evidence 
of cerebral congestion, which is exceedingly rare, is harmful rather 
than of value. Orschansky found that removal of one-seventh of 
all the blood in the body by the femoral vein did not lessen the 
irritability of the cortex, and Minksowsky ligatured all the blood- 
vessels going to the brain without decreasing its excitability. We 
know also that cerebral anaemia produces epileptic attacks. 

A very important point, which is constantly brought before the 
physician who is treating epilepsy, is that of diet. Nearly every 
patient inquires what he shall eat, when he suffers from this disease. 
Very few researches of a thorough character have ever been carried 
out on a large scale to determine the things which may or may not 
be ingested. Of course, nearly every one of us knows from our per- 
sonal experience that red meats are hurtful, particularly in children. 
Curiously enough the influence of diet in one research covering a 
number of cases of chronic epilepsy, seemed to be of little moment. 
Thus, Merson examined twenty-four such cases, putting twelve of 
them on a purely vegetable, and twelve on a purely nitrogenous 
diet. The result, after this had been continued for two months, was 
that the vegetarians had had a few less fits than the others, but the 
difference was so slight as to be almost of no weight in determining 
the question. Some authors at the present day believe this opinion 
as to the harmfuluess of meats to be erroneous, aud Gowers is one 
of them. 



EPISTAXIS. 

Nose-bleed depends upon many causes, the chief of which are 
traumatisms, plethora, the presence of ulcerations in the nasal 
chambers, and the prodromata of typhoid fever. 

Probably plethora is the most frequent cause of nose-bleed, and 



EPISTAXIS. 421 

in most instances is an attempt on the part of the system to rid 
itself of an excess of blood. Under these circumstances it is not 
dangerous nor is it worth while to treat it unless it becomes excessive. 
Where it is excessive, or where it must be controlled for any reason, 
the measures to be adopted are both medicinal and non-medicinal. 
If the person be full-blooded and strong, full doses of tincture of 
aconite or veratrum viride are useful, say 2 to 4 drops of one of 
them followed in a half hour by a smaller dose, if necessary. Some 
physicians have recommended ipecac in full nauseating doses to 
relax the arterial system. Powdered alum, pure, or half and half 
with starch, may be snuffed up the nostril, and tannic acid in powder 
or in solution may be used with advantage. If this does not control 
the haemorrhage an atomized spray of Monsel's solution in the 
strength of 30 drops to 4 ounces of water may be of service. Ergot 
in the form of the fluid extract in the dose of 1 drachm may be 
given, or its wine in the dose of a wineglassful employed. Some- 
times in slow oozing internal doses of turpentine, oil of erigeron or 
hamamelis do good. As a household remedy, vinegar may be in- 
jected into the nostril, or lemon-juice be employed in the same way. 

All these remedies act as styptics when locally applied, by causing 
coagulation of the fibrin and the formation of a clot, while the in- 
ternal remedies produce local contraction of the bloodvessels in the 
inflamed area, this area being more susceptible to the influence of 
these drugs than the rest of the vascular system. 

The value of these drugs depends upon their power of lowering 
blood-pressure, and in consequence decreases the leakage from the 
solution of continuity in the bloodvessel. 

The non-medicinal measures to be employed, if the bleeding be 
severe, consist in plugging the anterior nares with pledgets of cotton 
or pieces of lint soaked in vinegar. If this does not control the 
haemorrhage, the posterior nares may also be closed by plugs, and 
compression of the facial artery of the same side be made upon the 
superior maxilla near the nose, thus decreasing the blood supply. 
The head must be kept raised and the patient must not bend over 
or wear a tight collar. 

Sometimes, if the patient raises one or both hands high above the 
head, the haemorrhage ceases. This is due to the fact that the easiest 
pathway for most of the blood is straight up the brachial arteries 
rather than through the tortuous vessels of the face. A hot foot-bath, 
by dilating the veins of the lower extremities, draws away the blood 
from the face and is a useful measure. In other cases, a hot-water 
bag applied over the dorsal vertebrae is efficacious, and sometimes 
cold when so used is of service. A piece of ice pressed against the 
nose may prevent further haemorrhage, by causing localized anaemia. 

Where the nasal haemorrhage results from traumatism, with 
fracture of the bones, and great loss of blood ensues, ligation of 
the bleeding vessel or its supplying vessel should be, if possible, 
resorted to. 



422 DISEASES. 



ERYSIPELAS. 

This disease is dow being studied very widely, because of the gen- 
eral recognition that it is dependent for its existence upon a germ, 
and the dispute as to whether the disease is purely local or constitu- 
tional, in its milder forms or phases. The changes which have come 
forward in its treatment are chiefly the local measures, while those 
which have been used internally for many years have suffered no 
alteration. 

Whether or not erysipelas is a local or systemic disease has little 
to do with the proper treatment. In any case it is an inflammation, 
aud as such must be treated. In its early manifestations and where 
some uncertainty may exist as to its true character, aconite or vera- 
trum viride may be used in sthenic cases in which the nervous 
and circulatory systems give evidence of reflex irritation, and the 
pulse is hard and full. Those remedies are contra-indicated if any 
tendency to weakness exists. Da Costa has recommended, and others 
have carried out with success, the use of pilocarpine in sweating dose 
(s t° i grain hypodermically), in these early stages, and in some in- 
stances the injection may be made at the margin of the inflammation 
with advantage, as this method seems to control the development and 
spread of the disease. The objection to the use of these injections 
about the inflamed area rests in the possibility of the formation of a 
slough, which when infected would speedily change a superficial 
lesion into the phlegmonous form of the disease. As with aconite 
and veratrum viride, it is to be remembered that this use of pilocar- 
pine is not to be resorted to if debility exists. When asthma is 
present, or the disease is too far advanced to be aborted, belladonna 
in the dose of 3 to 5 minims of the tincture every four hours should 
be used. It may also be locally applied on lint with benefit, or 
belladonna ointment may be smeared on the skin. 

The internal treatment of erysipelas par excellence is the plentiful 
use of the tincture of the chloride of iron (20 to 30 drops, or even 
40 drops) three times a day. The diet should be regulated and the 
bowels kept in good order, while any excessive febrile movements are 
to be treated by the use of antipyretic drugs such as antipyrine. 
Where the patient passes into the typhoid state, supportive measures 
must be used and alcoholic stimulants added to the food, which 
should be predigested or prepared so as to be readily absorbed. 

During convalescence the use of tonics, both in the form of iron 
and bitters, is particularly indicated, if recovery of strength is slow. 
The local treatment of erysipelas is very varied, but in the majority 
of cases resort need be had to but one or two methods. By far the 
best dressing for the general run of cases of erysipelas is a modifica- 
tion of that of von Nussbaum which the author has tried in a 
number of cases with great success. The skin of the part involved 



FEET — SWOLLEN, TENDER, OR SWEATING. 423 

is carefully washed with castile soap of the purest form which is 
washed off by a 1 to 1000 solution of bichloride of mercury. The 
skin is dried with a soft towel and a thick coating of ichthyol 
and vaseline applied, the strength of this ointment being half and 
half. Over this are placed antiseptic gauze or sterilized absorbent 
cotton and adhesive strips, or a bandage is used to keep the dressing 
in place. Sometimes the ointment alone may be applied if the area 
is small. Under this treatment the results are often extraordinary 
in all stages of the malady. Where ichthyol is not obtainable, a 
thick coat of white lead paint, as it is sold in cans before it is mixed 
with any thinning substance, will be found of service in an emergency. 
The plan recommended by Higginbottom of applying nitrate of 
silver is often successful. It consists in the use of a solution of the 
strength of 80 grains to 4 drachms of distilled water, which is thor- 
oughly applied with a camel's-hair brush over the entire inflamed 
area, and a little beyond. The application must be made twice or 
thrice to secure a good coating. This treatment will often arrest the 
inflammation and prevent its spread, but has caused sloughing. 



EXHAUSTION AND DEPRESSION. 

While the treatment of both these conditions is almost identical in 
some respects, it is, nevertheless, important that a clear idea of the 
difference between the two be clearly understood, if for no other 
reason than that the physician may recognize that exhaustion is a far 
more serious state than depression. It also requires more careful 
treatment. The man who is depressed retains iu his body all the 
vital forces necessary for the maintenance of life, but they are tem- 
porarily in abeyance from some cause. As soon as the incubus is 
taken away, the system at once asserts itself and recovery takes place. 
This is not the case with a man suffering from exhaustion. In this 
patient every particle of his strength is sapped and lost. The man 
depressed is the giant lying unconscious from a blow on the head ; 
the man exhausted is that same giant after a long 'attack of typhoid 
or other fever of a similar nature. The treatment of depression is 
stimulation ; of exhaustion, not only stimulation, but feeding and 
protection from exposure. 



FEET-SWOLLEN, TENDER, OR SWEATING. 

These comparatively simple, yet annoying, conditions are often 
brought before the physician for relief, and patients suffering from 
them will frequently be more grateful for skilful treatment and 
relief than in the event of recovery from a severe illness. 



424 DISEASES. 

Swelling of the feet occurs chiefly in two classes of cases, except- 
ing, of course, dropsy. These are old persons taking too little or 
too much exercise, and who may have gouty or rheumatic tendencies, 
and those who, by constant stauding or walking, cause congestion of 
the lower extremities, chiefly by fatigue or bad shoes, or by uneven 
surfaces in the ground, causing bruising. Where the swelling takes 
place in the first class small doses of arsenic, in the dose of -^ to -^ 
grain, often do good, and careful examination should be made of the 
circulatory, renal, and respiratory apparatus to discover any weak 
points, such as vascular relaxation or tendencies to varicosities. The 
distilled or fluid extract of hamamelis is often of service in the dose 
of J to 1 drachm of the former and 10 to 20 drops of the latter 
preparation. In some cases absolute rest of the feet will be neces- 
sary before cure is reached. 

Where the feet are tender the most common cause is bruising from 
too thin soles on the shoes, too tight shoes, and from abrasions or 
skin disease. More commonly than all, they become sore from ex- 
cessive sweating and resulting maceration. 

The treatment of sweating and tender feet is, of course, the re- 
moval of the cause and the use of remedies designed to toughen and 
harden the skin of the parts. Probably the best application for this 
purpose is a solution of salicylic acid and borax, half and half, in 
water, and glycerine rubbed over the feet night and morning. If 
the sweating is very severe the stockings worn should be clean each 
day, and previously soaked in a strong solution of borax and dried. 
The following prescription affords a useful powder : 

R. — Pulv. acid salicylic gr. xx to xl. 

Pulv. acid boric . . . ... . . 5pj. 

Pulv. amyli . . . . . . . q. s. ^j. 

M. — S. To be dusted over the feet night and morning, after washing and 
thoroughly drying them. 

Sometimes the use of cotton instead of woollen stockings may aid 
in the cure. 



FEVER AND ITS TREATMENT. 

{For the Treatment of each Fever see its Title.) 

At the present time the medical profession are almost universally 
of the opinion that fever is a disorder of calorification dependent 
upon nervous action, such nervous action being the result of various 
causes, such as the presence of poisonous materials in the blood, or of 
perverted functional activity. The first may be represented by the 
fever of any infectious disease. The second by the so-called hyster- 
ical hyperpyrexia. Turning from the general question of fever to 



FEVER AND ITS TREATMENT. 425 

those of drugs which combat it, we are met at once by an array of 
synthetically prepared substances which are almost without number, 
and which are derived chiefly from the tar found always in close 
proximity to deposits of coal. 

The value of a drug which can decrease high temperature by in- 
fluencing heat-production alone cannot be over-estimated, and while 
several drugs seem to influence this part of the heat apparatus, more 
than that portion connected with the dissipation of heat, we have no 
substance which is distinctly and solely capable of exercising an in- 
hibitory power over the development of heat in the body. Fre- 
quently one of the substances put forward by its discoverer as a use- 
ful antipyretic remedy has been found so to depress the heart or res- 
piration that it cannot be used, while others produce secondary 
lesions in the tissues of the body by a more slowly acting influence. 
For both experimental and practical purposes we may, therefore, 
divide antipyretics into three great classes. First, the substauces 
which allay or prevent fever by inhibiting its production ; second, 
the drugs which possess the power of decreasing bodily temper- 
ature by increasing the dissipation and decreasing the production of 
heat, and third, the compounds which allay 'fever, not by stopping 
the manufacture of heat units but so increasing the exhalation of 
heat that the loss is greater than the manufacture. The first and 
third of these three classes are directly opposed to one another. The 
second class is halfway between, and it is to this class that most of 
our antipyretic drugs belong. The first is the ideal, the second is 
the one we have to be content with ; the third is the one used by 
our forefathers, and is the most dangerous and unreliable, since the 
tissues are quite as rapidly destroyed as before the drug was given ; 
the centre of the body remaining in pyrexia, while a cool skin and 
extremities are apt to lead the physician into the belief that the 
fever no longer exists. The tissue-waste of the fever goes on un- 
changed, and the patient, if the disease be prolonged or asthenic in 
character, is in almost as bad a way as when no such antipyretic 
attempt has been made. Almost as badly off, because it should 
never be forgotten that hyperpyrexia, or even ordinary fever, is 
dangerous in two ways, namely, by destroying tissue and reducing 
vital power, and by acting simply as too great bodily heat and 
thereby producing nervous or cardiac symptoms, such as are seen in 
cases of sunstroke and heat-exhaustion, where the condition of the 
patient is the result of coagulation of the cerebral or cardiac proto- 
plasm, or is one of depression of all vital function. 

Closely allied to this question is that which asks us to define what 
we mean by hyperpyrexia. As given by most workers upon fever 
this term is applied to any state in which the temperature reaches 
106° or 107° F. ; but in reality this has nothing to do, except in an 
indirect way, with what the student or physician wishes to know. 
This is but another example of the fact that the presence of a high 



426 DISEASES. 

temperature alone does Dot constitute the sole indications for the 
treatment of the disease, the physician being governed by the state 
of the patient who is laboring under the malady. A temperature of 
106° F. in a young healthy man, suffering from an attack of some 
short-lived disease, does not mean very great danger; but a tempera- 
ture of 103° day in and day out in typhoid fever does mean danger, 
and must be carefully attended to. In a simple continued fever 
106° F. is a hyperpyrexia In typhoid or other low fever 103° F. 
is a hyperpyrexia. The questiou is one not of actual degrees 
Fahrenheit, but rather as to whether the temperature present is 
doing any harm. 

Turning to the drugs, which are divided into classes, named 
from their physiological effects, we may, in view of our present 
knowledge, class them as follows : First, those which decrease 
heat-production alone are not known. Second, those which act both 
on dissipation and production are antipyrine, antifebrin, carbolic 
acid, salicylic acid, similar substances, and quinine. In this class, 
also, should be placed cold bathing, which probably decreases heat- 
production as well as increases heat-dissipation. Third, those drugs 
which only dissipate heat, as far as we know, namely, the great group 
of cardiac sedatives and their allies. 

No one is more sensible of the fact than the writer that this 
arrangement of the subject is partly artificial, but in the present 
state of our knowledge it probably is the best we can do. 

Though a number of writers have claimed that certain antipyretic 
remedies of equal power act with different results in different dis- 
eases, the writer has never been able to see any such distinction, aud 
we must be guided rather by experience as to the value of some 
particular antipyretic in all diseases than by any other rule. All 
observers are not in accord, however, as to the best one of this class. 
While phenacetin has been spoken of very highly by some authori- 
ties, the writer has heard it equally condemned by others, and 
although Kinger prefers antipyrine, Mitchell Bruce relies chiefly on 
antifebrin, while in America almost every one prefers the former 
drug, the general diffusion of this opinion apparently resting upon 
wide experience. While the number of cases of ill-effects recorded 
are small with antifebrin as compared with those of antipyrine, the 
idea prevails, and perhaps justly too, that the former is much more 
capable of harmful effects than the latter, and it cannot be denied 
that scientific basis of great weight exists for this belief. 

It may be said that we have only three measures for the relief of 
fever which are reliable aud have stood the test of time. These are 
antipyrine, acetauilide, and the use of cold. (For the mode of using 
antipyrine and acetanilide see pages 29 and 59, and for the use of 
cold see page 313.) 

For many years the profession of medicine has been in the habit 
of feeling the pulse with the perfectly proper object of determining 



FEVER AND ITS TREATMENT. 427 

what the state of the system is as it appears on this sign-board of the 
body, but it has ouly been of late, when our knowledge has increased, 
that we have come to consider the pulse rate and force as something 
more than a simple aid to diagnosis. At present many seem to for- 
get that the very value of the pulse, as a sign-board, depends upon 
its readiness to obey the beck and call of the variations in the body, 
and to consider that, in fever, for example, the pulse is rapid, not 
because the fever makes a rapid pulse, but that a rapid pulse and 
fever are equally dangerous conditions, both of them of primary 
importance ; in other words, these persons regard the rapid pulse, 
not as the result of a high temperature, but as a symptom in itself. 

While in our present state of knowledge, concerning the poisons 
which produce fever, we cannot assert that none of them act on the 
heart in the same manner as does a drug, thus altering the pulse rate 
and force ; we are able, by experiments, to prove that high tempera- 
tures of themselves do seriously alter the heart-beat, and, in addition, 
that antipyretics, as a general rule, in lowering the fever lower the 
pulse, not directly, but indirectly. Such results are to be gleaned 
from the studies of Lauder Brunton, Newell Martin, and several 
other workers in this field, who have fouud that febrile temperatures 
stimulate the accelerator cardiac nerves. 

Closely associated with this question is that of the relationship 
between arterial pressure and fever. It at once becomes evident that, 
if heat stimulates the accelerator nerves, an increased rapidity of car- 
diac action must ensue, and, in consequence, an increase in the amount 
of blood thrown into the arteries must result. As a consequence 
of this the arterial pressure must rise, even if the vaso-motor system 
gives response in no way to the heart. In nearly all cases of high 
fever, however, unless the system be greatly exhausted, the vaso- 
motor apparatus certainly is excited to increased activuy. 

As the writer has spoken of the dangers of high fever it is not right 
that the impression be given that every one believes with Liebermeister 
in the absolute harmfulness of such states. While the profession in 
general accept such views the opponents to them, while not larger in 
number, have beeu so prominent, as individuals, that their studies 
cannot be passed by. In 1883 Unverreicht tried to rebut the testi- 
mony then so rapidly accumulating in favor of antipyretic measures, 
and, still later, Naunyu, in a very carefully written and logical 
paper, denied positively their value and usefulness. While he grants 
that high temperatures are most important in prognosis and diag- 
nosis, and that certain antipyretic measures do good, he, never- 
theless, insists that, though the cold bath does good primarily, its 
effect upon the nervous system nullifies its direct action upon the 
fever. He acknowledges, of course, that such temperatures as 108° 
or 110° F. are of dangerous import in themselves. To prove that 
his assertions are correct, Naunyn gives results reached in a series of 
studies made by him on animals. He found that healthy rabbits 



428 DISEASES. 

will bear a temperature, artificially induced, of 106° to 107° F., rising 
at times to 108° to 109° F. for days together without any injury. 
He further states that in many autopsies he has failed to find any 
lesions present as the result of exposure, except a slight cloudiness of 
the renal epithelium. The author cannot help calling attention 
to two facts which Naunyn apparently overlooked, as well as 
many of the readers of his paper, namely, that 106° to 107° F. 
are only a few degrees above the rabbit's normal heat, which is 
about 103° F., so that the pyrexial temperature of these animals 
corresponded to but 101° or 102° in man, a temperature easily borne 
in many fevers. Second, it should be remembered that this heat 
was applied constantly in these studies to the animal, which did not 
have to manufacture the heat itself. Although, at first, this seems 
unimportant, it should not be overlooked, as the tissue-changes in 
the two instances are entirely different ; to use a homely simile, in 
one case the stove is kept going by heat applied to it externally 
without the combustion of its tissues, the coal ; in the other case, the 
stove is kept hot by the use of the coal itself. Very different changes 
are naturally found in the two cases in the coal. The author cannot 
go further into these questions; suffice it to state that while high 
temperatures are borne in some instances with no evil results, the 
majority of cases do not turn out so favorably. 

The various opinions expressed by well-known German clinicians 
concerning this question have been condensed by Ziemssen. Speaking 
of the worth of antipyresis in any form he divides the writers of the last 
twenty years into groups, as follows : First, the extreme hydriaticists 
who use only cold bathing and object to internal antipyretics, such as 
Vogel, Winternitz, and others. Second, the moderate hydriaticists, 
who resort to lukewarm baths, but reject internal antipyretics, among 
whom may be named Naunyn, and others. Third, those who, ac- 
cording to indication, resort to moderate hydropathy and to anti- 
pyretics, such as Jiirgenson and Reiss. Fourth, those who consider 
fever as a salutary and necessary regulator, and only resort to anti- 
pyretics when dangerous symptoms arise, as Heubner, Curschmanu, 
and others. Fifth, those who claim that fever is a necessary phe- 
nomena, and, therefore, reject all attention to antipyresis and attend 
to diet (Glaser). Those who absolutely deny the influence of treat- 
ment on the mortality of fever (Port). 

Truly, it would be hard to find a set of more diverse and contra- 
dictory opinions on so limited a basis, but the practice of Jiirgensen 
and Reiss has virtually proved its value and it is resorted to by most 
of us. Those who have tried it rely on this method very largely 
and it has been found to be of great benefit, and is certainly an 
advance in therapeutics. 

A very important question arises as to the value of the cold 
pack in private practice. There can be no doubt of its acting well 
under these circumstances if carefully carried out, and it is cer- 
tainly much the best remedy for fever where trained nurses are 



STHENIC FEVERS. 429 

on hand to administer it, but where only members of the family 
are in care of the sick man, and where the doctor can only be on 
hand once in twenty-four hours it is manifestly impossible to re- 
sort to it. Even if the bath be properly given the exhaustion pro- 
duced by clumsy handling may more than counterbalance all the 
good achieved. It has been claimed that the cold pack never results 
in cardiac failure as does the use of antipyretics. We are quite con- 
fident of the fallacy of this statement. Indeed, the writer has re- 
cently seen such a case. The cold pack cannot be used more care- 
lessly than antipyretic drugs, and it is probable when this measure is 
more widely employed more reports will appear in the medical maga- 
zines of such accidents occurring as the result of its abuse. (See 
Cold in Fevers, p. 313.) 



Sthenic Fevers. 

The application of antipyretics to the febrile temperatures occur- 
ring in sthenic cases has an entirely different outlook and purpose 
than their employment in the prolonged low fever of the adynamic 
type. There can be little doubt that in the sudden excessive out- 
bursts of febrile temperature in a child, with no acute disease under- 
lying it, antipyretics are of great value, and there are also reasons 
for their employment in order to favor popular prejudice. In Amer- 
ica, at least, a physician visiting a case of croupous pneumonia for 
the first time and finding the patient with a high fever would not be 
allowed to give the patient a cold bath if the friends could prevent 
it, and he must, in consequence, fall back upon antipyretics. Again, 
the fever of such cases cannot be prolonged enough to necessitate 
the use of antipyrine day in and day out for weeks at a time, and 
there is, therefore, less danger of the patient being injured by its 
influence. In scarlet fever the use of such remedies should be most 
carefully watched, for the double reason that the kidneys are in 
danger and that the disturbances accompanying the fever may last a 
long time. 

In pneumonia and erysipelas in strong persons antipyretics find 
their true place. Lasting about a week in their febrile activity 
these diseases are often accompanied by sudden hyperpyrexia which 
must be overcome at once by a drug, and they are so apt to rise at 
any time to a dangerous temperature that some remedy often has 
to be left in the hands of the nurse with instructions to use it if a 
hyperpyrexia should assert itself. 

In thermic fever or sunstroke the employment of antipyretics is 
often useless. The excessively rapid upward rush of the temperature 
responds in no way to drugs, and there are cases on record in which 
the use of antipyrine has utterly failed of good result. Thus, in 



430 DISEASES. 

one case reported by Singer, a man suffering from thermic fever 
with a temperature of 108 degrees received 50 grs. of autipyrine 
hypodermically at 6 p. m., at 7 P. M. he received 10 grs. more under 
the skin, at 8 P. m. 20 grs. more, and at 9.30 another 20 grs. were 
used without effect. In other words 100 grs. in three and a half 
hours proved useless. In childreu suffering from excessive heat 
during summer weather autipyrine seems to be very useful, and has 
been highly recommended by Demme. 



Asthenic Fevers. 

{Typhoid Fever and Fevers of a Typhoid Type.) 

In the opinion of the author antipyretics should play a secondary 
role in the reduction of the pyrexia of the typhoid state, our main 
reliance being upon cold applications, the antipyretics being used 
as an adjunct to help the cold pack or bath. Aside from the fact 
that he has found such an opinion well founded in a large number of 
typhoid fever cases, logical reasoning endorses its correctness. Even 
if antipyretics were perfectly innocuous, their constant use in fever 
would but give the already over-strained kidneys the task of their 
excretion, while the stomach, sufficiently disturbed by necessary 
medicines and illness, has enough to do without an additional load. 
Further than this, we know that these drugs are not perfectly harm- 
less, and we also know that they act on the protoplasm of the body, 
and in consequence must gradually lose their power, which is not the 
case with the cold pack. The writer is sure that in typhoid and 
other low fevers of the continued type antipyretics should be given 
only when the cold pack cannot be used or at the end of the cold 
application, to prevent the temperature from bounding upward after 
its depression. Further than this, fever will sometimes resist all 
doses of antipyretics we can give, or all that it is safe to give, but no 
fever can resist the cold pack. In diseases of a more chronic type, 
particularly those represented by phthisis, antipyretics are of doubt- 
ful value, owing to the increased sweating which is so apt to be 
produced, and unless the patient seems to be particularly robust they 
should not be employed except in the smallest available doses. 

FRECKLES AND CHLOASMA. 

The removal of freckles is readily accomplished, but their return 
is inevitable if any exposure to the sun or wind occurs. One of the 
best applications for their removal is a solution in water of corrosive 
sublimate varying in strength from 1 to 4 grains to the ounce, and 
applied night and morning until the skin shows that it is irritated, 



GASTRALGIA. 431 

when it must be stopped for some days, after which its use may 
be begun again. A very efficient, and much less dangerous remedy 
to leave about the room where children are allowed to play, is a 
saturated solution of boracic acid in water applied in the same 
manner as is the solution of bichloride. 

Another remedy is lactic acid, 10 grains to a drachm of water, 
used in the same manner as the solution of the bichloride of mercury. 
The following prescription is recommended by Unua : 

R.-Bismuthioxidn ..... M gl , xxx . 

Kaolin gj. 

Glycerinae i . . f.^ij. 

Aq. rosfe . . . . . . . q. s. fjij. 

M. — S. Paint on spots and allow to dry, washing off before each application. 

Or the following may be used : 

R. — Zinci oxidi ....... gr. iij. 

Hydrarg. ammonia. ..... gr. jss. 

01. theobromse ...... fgijss. 

01. ricini ....... f^ijss. 

Essent. rosae . . . . ... gtt. x. 

M. — S. Apply night and morning. 

GASTRALGIA. 1 

The treatment of gastralgia may be divided into two parts — that 
directed to the relief of the attack when it is present, and that 
devoted to the prevention of other attacks. During the acute stage 
hot applications and drinks, aromatic and locally stimulating warm 
infusions, a few drops of chloroform, or brandy, or whiskey, hot and 
concentrated, or 30 or 40 drops of laudanum, may be used. Counter- 
irritation often does good, and in some cases, particularly if a suspi- 
cion of an hysterical element exists, a vigorous revulsive may act 
with surprising power. Emesis and purgation are sometimes indi- 
cated, since in the early attacks the cause of the pain may be sus- 
pected to be the presence of indigestible food. 

The treatment required in the intervals between the attacks must 
vary with the cause and with the general condition of health. A 
careful search must be made for the real cause of the trouble, and 
when found it must be removed or palliated by appropriate measures. 

The diet should be carefully regulated, and all the hygienic details 
of the patient's life be critically studied and directed. The avoidance 
of improper food, the abandonment of tea, coffee, or tobacco, the 
prescription of proper dress, exercise, or change of residence, may be 
followed by marked improvement in general health and by a cessa- 
tion of the attacks of gastralgia. 

In regard to remedies, it may be premised that all depressing 
drugs must be avoided, as well as all purgatives which would 

1 See article written by author in Keating's Cyclopaedia of Diseases of Children, 
vol. iii. 



432 DISEASES. 

weaken the digestion. Any marked disturbance of digestion should 
be corrected ; and this may require the use of pepsin, or of some 
tonic remedies such as was suggested in the article on Indigestion. 
The chief reliance is, however, to be placed upon the administration 
of arsenic and iron immediately after meals, in proper form and 
doses. Thus, we may direct : 

fy. — Liq. potassse arsenitis f zj. 

Yini ferri amari . . . . q. s. ad f^iv. 
M. — S. From 30 to 60 minims in water after meals, three times daily, for a 
child of six years, or twice this quantity for an adult. 

Or, 

R. — Tinct. ferri chloridi . . . . ' . fgj. 
Acidi muriatici diluti ") .. -~ 

Liq. arsenici chloridi J aa 3 SS - 

M. — S. From 4 to 20 drops in water after meals, three times daily. 

Occasionally even better results are secured by the use of cod-liver 
oil in emulsion with hypophosphites. 

It is well, in cases where the tendency to pain is decided, to com- 
bine with the above the use of a powder of bismuth subnitrate and 
saccharated pepsin, given about an hour or an hour and a half after 
meals. Constipation, should it exist, must be overcome by proper 
diet, massage, enemata, or by suppositories of gluten or glycerin 
or soap. If the bismuth favors its continuance too decidedly, small 
doses of cyanide of potassium, dilute hydrocyanic acid, or chloro- 
form may be substituted at the same hours. In cases where a 
highly neurotic state exists, it may be necessary to alternate all other 
treatment with the bromides or preparations of valerian. 



GASTRIC CATARRH, ACUTE. 

By far the most important point in the treatment of acute gastric 
catarrh is the regulation of the diet, and the following abstract from 
the article written by the author for the third volume of Keating's 
Cyclopcedia of Diseases of Children, embodies the ideas which the 
writer desires to express, so thoroughly, that he has inserted it here. 
This may be divided into two parts — first, the regulation of the 
food during convalescence or during the attack, and second, the 
character of the food to be used during the interval following one 
attack and preceding the next. Total abstinence in the acute 
stages of the attack, and absolute bodily and mental quietude, 
are advisable. There are several reasons for this. In the first 
place, the juices of the stomach are in an abnormal state and unfit 
to receive more food. Secondly, the mucous membrane of the 
stomach is already hypersemic from the inflammation, and, as the 
normal viscus takes on a physiological hyperemia on the ingestion 



CHRONIC. 433 

of food, we would add to the congestion of the bloodvessels did 
we allow more nourishment to enter the viscus. Last of all, the 
excess of the mucus and lactic and butyric acids present renders any 
new food impure before it can be assimilated, and so prolongs the 
trouble. As the attack passes off, small amounts of food may be 
given, readily digestible and not likely to become easily decomposed 
or rendered acrid by the mucus in the stomach. Milk with a large 
percentage of lime-water is to be used, since the alkali not only pre- 
vents a too firm coagulation, but also decreases the secretiou and 
action of the mucus. The thirst is often excessive, although anorexia 
is complete, and small pieces of ice may be administered for its relief. 
Commonly it will be found that the patient rapidly improves up to 
a certain point, then stops or relapses. This is due to an accumula- 
tion of mucus, which undergoes fermentation, and, if marked evi- 
dences of the presence of this secretion are given, a mild and gently 
acting emetic may be employed to dislodge the fermenting mass. 
Sodium bicarbonate with compound infusion or compound tincture 
of gentian may be used in convalescence, and small sips of efferves- 
cing draughts are useful. If constipation exists and vomiting forbids 
the use of the ordinary purgatives, a Seidlitz powder divided into 
fourths or fifths and taken in this way every fifteen minutes or half 
hour will settle the stomach, move the bowels, and often carry away 
mucus. 

If there is much epigastric distress, a spice poultice is often of 
service. 

Sweets and starches are to be rigidly denied the patient. If 
anaemia exists, iron may be used ; but this is rarely needed. 

The abdomen should be carefully protected with flannel, and 
draughts and unsanitary surroundings avoided. 

The use of pepsin and of hydrochloric acid is to be much more 
thoroughly attended to than has heretofore beeu the custom. As a 
rule, we are apt to forget that pepsin acts largely by catalysis, and 
that it is not secreted as pepsin, but as pepsinogen, a substance which 
is changed into pepsin in the presence of an acid. For this reason 
hydrochloric acid should be freely employed, and pepsin given in 
large or small quantity according as there is reason to believe this 
ferment to be in normal or abnormal amount. Common salt (sodium 
chloride) is virtually identical in its ultimate influence with hydro- 
chloric acid, and should be always used, in moderation, with the 
food. 



Gastric Catarrh, Chronic. 

Chronic gastric catarrh is a condition of the stomach commonly 
seen in this country in a more or less active form. It is often asso- 
ciated with much indigestion and the eructation of some liquids, or 

28 



434 DISEASES. 

even with active vomiting. The secretions of the stomach are nearly 
always abnormal, and fermentative changes are constant in the gastric 
contents. 

By far the best treatment for this condition is the use of counter- 
irritation over the epigastrium, the close regulation of the diet, and the 
use, internally, of nitrate of silver and extract of hyoscyamus, or, if 
any hyper-acidity exists, the addition of the subnitrate of bismuth. 
Constipation is nearly always present, and should be removed by 
appropriate drugs, such as cascara sagrada. 

All fats, rich foods, strong meats, ham, bacon, or fried things are 
to be avoided, and only light broths, koumys, or matzoon resorted to. 
The nitrate of silver pill should be used half an hour before each 
meal, and be prescribed as follows : 

R . — Argent, nitrat. . . . . . . . gr. fv. 

Ext. hyoscyam. . . . . . . . gr. x. 

M. — Ft. in pil. No. xx. S. One, half an hour before each meal. 



GASTRIC DILATATION. 1 

The treatment of dilatation of the stomach may be divided into 
two varieties — the first consisting of the methods of cure which are 
directed against the diseased state of the gastric walls themselves ; the 
second, of those methods in which abnormal changes in the food and 
the gastric contents and secretions are combated, thereby allowing 
reparative changes to take place. As is well known, dilatation of 
the stomach may be dependent upon either some constitutional or 
some local cause. If the cause be rickets, it is evident that the mal- 
nutrition of the bony system and of the system in general is to be 
improved, and that remedies devoted to this object are to be given — 
cod-liver oil by inunctions, or, if the digestive apparatus will bear it, 
by the stomach. Lacto-phosphate of lime, phosphate of sodium, or 
iron, often in the form of the syrup of the iodide, should be used if 
any signs of struma are present. Good foods, possessing large 
amounts of salts, yet easy of digestion, are, under these circumstancs, 
particularly desirable, and by far the larger part of the treatment 
should be directed to the dietetics of the case. Of this the writer 
shall speak farther on. 

There are several means to be employed for the relief of gastric 
dilatation other than those which can be called medical, so far as 
drugs are concerned 

These consist, first, in efforts to evacuate the stomach and to cleanse 
it ; secondly, in attempts by these and other means to prevent its 
distention by the gases which arise or by the accumulation of ingesta 

1 See article by author in Keating's Cyclopaedia of Diseases of Children, vol. iii. 



GASTRIC DILATATION. 435 

which takes place ; thirdly, in the regulation of the diet so as to 
avoid causes which have a tendency to increase the disorder. 

Dilatation of the stomach is so difficult to cure that very satis- 
factory results are not to be looked forward to, but, nevertheless, the 
nutrition and the general state of health are to be carefully con- 
sidered. 

Taking up seriatim the non-medicinal means which we have named, 
we come at once to the consideration of lavage, a method which has 
been resorted to with most thorough trial on the continent of Europe. 
Originally proposed by Epotius in 1863, it has been most widely 
employed in children by Epstein, who in one article alone records its 
employment in two hundred and eighty-six cases of gastric disease 
in infancy, the patients being less than one year of age. 

Epstein employs a No. 8 or a No. 10 Nelaton catheter for the 
tube, and warm water holding in solution a little benzoate of magne- 
sium, the latter being resorted to chiefly when fermentation and de- 
composition products are present. If none of these conditions are 
present, ordinary water will usually suffice. The liquid employed 
should always be warmed. Others — as, for example, Lorez — use 
the ordinary English catheter, of the size known as No. 11 or No. 
12. The question as to the variety of tube to be employed is a vital 
one, since a poorly-devised apparatus not only gives no relief, but 
disgusts both the patient and the physician with the technique of the 
method. The tube should be more like a hollow bougie than like a 
catheter, in order that its calibre may be great enough to carry off 
some of the semi-solid matters present. If this rule is not carried 
out two evil results follow. In the first place, the tube and its aper- 
tures rapidly, or even at once, become clogged ; secondly, the liquid 
is drained away, leaving behind a mass which is semi-solid, to be 
sure, and less bulky, but which is, nevertheless, the quintessence of 
the nastiness of fermentation, and quite as qualified to leaven any 
fresh food on its entrance as the liquid would be. 

The holes in the gastric end of the tube should therefore be large 
enough to take in fairly large masses. In some cases the ordinary 
siphon may be used, but where there is any solid food or resistance, 
suction by meaus of a stomach-pump is necessary. 

The tube should be, for a child, twenty-four or thirty inches in 
length. The methods by which lavage is employed, further than 
those we have named, are as follows : The catheter or tube should be 
passed backward against the roof of the mouth, so that by following 
the curve of the hard and soft palates it is directed into the pharynx 
and oesophagus, and then by gentle pressure forced on down into the 
stomach. The irritability of the pharynx rapidly disappears, and it 
is surprising how quickly the patient may become accustomed to the 
operation, and submit to it without any feeling of discomfort. After 
the tube has reached the stomach, a small funnel is to be fitted in its 
external eud, which is then held above the head of the patient while 



436 DISEASES. 

water prepared in the way we have mentioned is poured into it until 
the stomach is filled, when the funnel end is lowered and the stomach 
is emptied by siphonage. 

The stomach-pump has one very serious disadvantage, which is 
present with even more force in the case of a child than iu the adult, 
namely, the danger of injury to the coats of the organ. This appa- 
ratus is also more costly and cumbersome, and for children the siphon 
is powerful enough in its action to take away all excuse for the use of 
the more complicated apparatus unless the contents of the stomach 
are in bulk. 

It is particularly necessary in children, on account of the lack of 
intelligent aid and their liability to gulp, that every care should 
be taken that the tube does not slip entirely out of reach into the 
stomach, and for the prevention of this danger a string should be 
attached to the exterual end of the tube before it is introduced, and 
the tube- should always be at least thirty inches in length. 

The treatment of dilatation, to be considered after lavage, is die- 
tetic. There can be no doubt that one of the chief reasons for the 
emaciation which comes on is the failure on the part of the stomach 
to digest and assimilate nourishment. In addition to this, the intes- 
tine is really the place for absorption of food to take place, and the 
delay of the food in the stomach virtually makes the chyme unfit for 
the function of the small intestine. 

The foods to be given are, of course, to be in the highest degree 
capable of ready assimilation, and should be confined, especially in 
severe cases, to the materials which we can readily predigest by the 
employment of the digestive ferments now so largely sold. Carefully- 
skimmed milk is valuable, aside from its inherent usefulness, in that 
it lacks the fats which can be utilized only in the intestines, and 
which simply break down and decompose if kept in the stomach. 
Oyster broth, carefully freed from any oily matters in cooking, and 
thoroughly pancreatized, is to be given. 

Rectal alimentation to some degree is always useful, particularly 
in older children, and Ewalcl, of Berlin, suggests the following 
nutrient enema : Beat up two eggs Avith a tablespoonful of cold water ; 
to this add a little starch, boiled in half a cupful of a twenty-per- 
cent solution of grape-sugar and a w T ineglassful of red wine. The 
solution is to be well mixed at a temperature not high enough to 
coagulate the albumin, and injected as high up into the bowel as 
possible. For a child this mixture should be somewhat less in 
quantity than that given above for the adult, particularly as to the 
wine. 

An exceedingly important part of the dietetic treatment of gastric 
dilatation consists in the constant bearing in mind of the fact that 
the tendency of food is to accumulate, and the avoidance of the per- 
nicious habit of adding solids or liquids to the quantity of ingesta 
still remaining from a previous meal. If the child is old enough, 



GASTRIC ULCER. 437 

all the remains of previous feedings should be removed by lavage 
before anything more is given, since otherwise the sweet food is at 
once contaminated by the liquids which it meets in the stomach. 

The medicinal treatment of gastric ectasy is, unfortunately, very 
limited, so far as the stomach itself is coucerned, and, indeed, we 
doubt whether any direct medication can ever be of much value unless 
in the form of disinfectant substances, such as we have spoken of in 
studying lavage, and these only prevent decomposition of the food 
and do not effect a cure. 

In a case of marked gastric dilatation we should, nevertheless, 
always resort to the bitter touics, such as gentian or calumba, and 
for the improvement of the muscular coats of the viscus employ the 
tincture or extract of physostigma in the dose of respectively 5 to 10 
drops or ^ to J of a grain. 



GASTRIC ULCER. 1 

In the treatment of gastric ulcer the general health and the use of 
those foods which will conduce to health and strength and at the 
same time not interfere too greatly with the stomach are to be 
attended to. 

In the way of drugs internally we would recommend the alkalies 
and bismuth, or small doses of opium, titrate of silver in small 
amounts, frequently repeated, combined with belladonna or opium is 
of great value in all such cases, and should be persistently employed 
in some such manner as follows : 

R. — Argenti nitrat. . . . . . . . gr. iv. 

Ext. hyoscyami . . . . . gr. x. to xx. 

M. — Ft. in pil. jfro. xx. S. One t. d., a half hour before meals. 

Counter-irritation should be applied to the belly for the relief of 
the pain and tenderness, to remove the local congestion and affect 
the morbid process favorably. This counter-irritation, in our opin- 
ion, should be of the mild continuous type rather than of the severe 
and fleeting character, and for this purpose the ordinary spice plaster, 
made of pepper, cinnamon, allspice, and cloves, may be employed. 
In the collapse following haemorrhage or perforation into the ab- 
dominal cavity cardiac stimulants should be carefully and guardedly 
administered, lest by an excessive action they increase the haemor- 
rhage, while for the direct resuscitation of the patient external heat 
and rubbing of the extremities should be resorted to. Bordeaux 
wine, preferably of considerable age, should be employed as a stimu- 
ulant if the use of alcohol is to be kept up for any time. In the 
early stages of the collapse the alcohol should be hot and fairly con- 
centrated. If the patient is conscious small pieces of ice may be 

1 See article by author in Keating's Cyclopaedia of Diseases of Children, vol. iii. 



438 DISEASES. 

swallowed to control the haemorrhage, and ergot may be given with 
the same object in view. 

The vomiting should be stopped, since it may increase the haemor- 
rhage, and for this purpose the usual remedies are to be employed, 
including both those which act centrical ly and those which act peripher- 
ally. Bromide of sodium in weak solution may be injected into the 
rectum for this purpose in the following form : 

J&. — Sodii bromidi . . . . . . 33s. toj. 

Tr. opii ....... fgj. 

Aq. . . . . . . . q. s. f^iv. to vj. 

M. — S. Inject into rectum. 

In regard to the diet it should be light and easily assimilated, and 
should be one whose chief digestion and assimilation will be intes- 
tinal, not gastric, since by this means we largely avoid the exposure 
of the raw surface of the ulcer to the acid gastric juices. In some 
cases the patient should be fed only by the rectum, by means of arti- 
ficially digested food, which is also very useful when given by the 
stomach. 



GASTRITIS, ACUTE. 

This is generally due to the ingestion of irritant foods or drinks, 
rarely arising in its true, acute form from other causes. 

The treatment is to be directed entirely to the prevention of the 
spread of the inflammation and to the relief of that already devel- 
oped. If the patient is seen soon after the onset of the trouble, the 
stomach is to be emptied of all irritant substances by means of vom- 
iting induced by large draughts of warm water, or, better still, by 
the use of the stomach-pump, as the retching may increase the irri- 
tation. Mucilaginous drinks are to be given freely, and albu- 
minous materials seem especially useful. Oils and similar protective 
liquids aid in preventing further damage. Opium, to allay pain and 
the local and systemic irritation, is invaluable. It should always be 
given in liquid form, and the deodorized tincture is the best in this 
respect, owing to its freedom from narcotine. Paregoric contains too 
little opium to be of value, and is irritating because of its volatile 
oil. If the stomach will bear no drugs they should be given by the 
rectum. If evidences of collapse appear, hot applications, atropine, 
or belladonna should be exhibited. It is important that the heat 
should be applied over the epigastrium and chest, and a flaxseed 
poultice is the best method of doing this. 



GLAUCOMA. 439 



GASTROENTERITIS. 

Gastroenteritis is a condition of inflammation affecting the entire 
alimentary canal in some instances, and commonly produced by the 
ingestion of some irritant substance, either in the form of bad food, 
poisons, or mechanical irritants, such as grape seeds or cherry stones. 
The symptoms accompanying it are exceedingly various, but consist 
chiefly in pain of a griping character with watery or mucous stools, 
or, if the inflammation be very severe, absolute and unyielding con- 
stipation may be present. The nervous symptoms depend upon the 
degree of irritation and the general nervous tendency of the patient, 
and, if the trouble is very severe, may go on into shock or collapse. 

If the irritation is very intense exfoliation of the mucous mem- 
brane may take plac^, the epithelium coming away in shreds. 

The treatment of gastro-enteritis depends upon its severity and 
.cause. Almost always we first allay the pain and tendency to inflam- 
mation by the hypodermic use of morphine, and immediately follow 
this or precede it by an emetic of a non-irritating and rapidly acting 
type, such as apomorphine, provided there is reason to believe that 
the poison or food still remains in whole or in part in the stomach. 
Following this, or in place of it, if emetics are not useful because 
the poison has already passed through the pylorus, castor oil in the 
dose of 2 to 3 tablespoonfuls to an adult may be given to sweep 
out the offending materials and lubricate the intestinal walls. In 
other cases sulphate of magnesium may be used but not sulphate 
of sodium or Rochelle salt, as they are both irritant. Having 
gotten rid of all offending materials opium and sulphuric acid are 
to be freely used to allay irritation and control diarrhoea (see Diar- 
rhoea), and hot compresses are to be applied to the belly, or a spice 
or mustard plaster used instead. Vomiting when excessive is to be 
treated in the manner described under that head. 



GLAUCOMA. 

Glaucoma, or that disease dependent upon an increase of intra- 
ocular pressure, appears in an acute or chronic form. The disease in 
general terms is characterized by halos appearing about the gas-light ; 
periods of obscuration of sight ; shrinking of the nasal half of the 
field of vision ; narrowing of the anterior chamber of the eye ; anaes- 
thesia of the cornea ; and increased tension of the eyeball. In the 
" glaucomatous attack," or acute glaucoma, the iujection of the eye- 
ball is intense; the lids swell, there is photophobia, the cornea is 
steamy, the pupil dilated aud motionless, and the vision rapidly 
destroyed. The case may be mistaken for iritis or acute ophthalmia 
— a fatal blunder. 



440 DISEASES. 

Iridectomy or an equivalent measure is the only treatment for 
glaucoma. If for any reason this is delayed, a solution of the 
sulphate of eserine should be dropped into the eye (gr. 1 to 2 to the 
ounce) every two or three hours until relief follows. Atropine must 
not be employed. Hot compresses, opiates, and leeches are also useful 
to alleviate the pain, if for any reason operation is delayed. 



GONORRHOEA. 

The therapeutics of urethritis varies in accordance with whether 
the disease is acute or chronic, and is very greatly modified by the 
seat of inflammation ; a posterior urethritis, for anatomical and 
mechanical reasons, not being amenable to the same treatment which 
will prove successful when the disease invades the penile portion ot 
the urethra. 

The membranous and prostatic portions of the urethra constitute 
its posterior part. They are surrounded by layers of powerful mus- 
cles which keep the canal constantly occluded, and which play the 
part of vesical sphincters. Hence, any injection forced into the ure- 
thra passes to but not beyond its membranous part, and is worse 
than useless if administered with the intention of combating inflam- 
mation of the posterior urethra. 

Since the general acceptance of the gonococcus as a specific cause 
of gonorrhoea the treatment of acute anterior urethritis has been 
mainly antiseptic, those drugs being chosen w T hich are found to 
act most powerfully upon the specific germs and at the same 
time produce the least irritant action upon the mucous membrane. 
Bichloride of mercury, as representing the most powerful germicide 
known to medicine, has been used most extensively. The main 
objection to its action lies in the fact that when employed in 
efficient strength it is exceedingly irritating. This effect may, to 
an extent, be avoided by using a large quantity in dilute solution, 
and one of the most satisfactory treatments yet advocated consists in 
thoroughly and repeatedly flushing the urethra with bichloride 
lotion 1 to 20,000 or 1 to 40,000. This may be accomplished 
by means of a bulbous catheter provided with numerous small 
apertures opening backward, just behind the enlarged extremity; 
immediately after urination the bulb is carried to the membra- 
nous portion of the urethra, the tube from an irrigator is then at- 
tached to the extremity of the catheter, and one or two pints of 
dilute mercury solution, as hot as can be borne, are injected. This 
may be repeated once or twice daily. When the urethra is so sensi- 
tive that the passage of an instrument is not practicable, a conical 
nozzle carrying a supply and a drainage-pipe, and of a size to close the 
meatus entirely when inserted, may be employed for irrigation. The 



GONORRHOEA. 441 

drainage-pipe should be of slightly smaller calibre than that which 
carries the solution into the urethra. This insures the passage of the 
injection back as far as the membranous portion of the urethra, beyond 
which it will not pass if the pressure does not exceed that obtained 
by elevating the irrigator two feet above the level of the urethra. 
When neither of these methods of irrigation can be practised a syringe 
with a conical nozzle and with a capacity of at least one ounce may 
be employed ; this should be used six or eight times a day, two syringe- 
fuls of the dilute lotion being injected immediately after urination. 
The liquid should be forced in very gently, being allowed to flow 
out by slightly lessening the pressure of the nozzle upon the meatus 
when the anterior urethra is full. When large injections are at- 
tempted by the ordinary small urethral syringe, the frequent appli- 
cation of the latter to the meatus occasions much irritation. As a 
precaution against forcing the injection into the posterior urethra the 
patient may be instructed to sit with the weight of the body bearing 
upon a folded towel placed beneath the perineum. These copious 
irrigations inaugurated in the earliest stage of gonorrhoea are fre- 
quently successful in producing a complete cure in a few days. 

Much stronger solutions of mercury are frequently employed, the 
concentration depending upon the subjective sensations of the patient 
and varying from 1 : 1000 to 1 : 4000. 

The addition of other antiseptic agents to the mercury solution 
has been found advantageous. A favorite prescription of Dr. J. 
William White is : 



]£ . — Hydrarg. chlor. corros. 
Zinc sulpho-carbolat. 
Acid, boric. . 
Hydrogen peroxide 
Aquae 



gr. ij. to iv. 
gr. ij. to x. 

Jf j "- 



The strength of this should be varied to suit the individual. 

Any of these ingredients may be used alone or in combination. 
Either individually or together, they probably represent the most 
efficient topical medication which modern treatment has approved. 
Where the gonorrhoea has already assumed a markedly inflammatory 
type, with swelling and oedema of the penis, redness and eversion of 
the meatus, and great sensitiveness of the urethra, no injection should 
be employed. The penis should be wrapped in cloths kept wet with 
alcohol and water, or lead-water and laudanum. With the subsi- 
dence of acute inflammatory symptoms and the appearance of copious 
discharge, the injection treatment may be inaugurated. It must be 
remembered that injections may in themselves prevent the discharge 
from entirely disappearing. Hence, as the symptoms ameliorate, the 
injection should be made less frequently ; finally being entirely 
omitted for some days if the discharge seems to continue longer than 
usual. 

Internal medication and constitutional treatment are most impor- 



442 DISEASES. 

tant in all forms and stages of gonorrhoea. It is almost universally 
accepted that certain drugs, such as copaiba, cubebs, and oil of san- 
dalwood, when eliminated through the kidneys, possess the power of 
inhibiting the growth of the gonococci or of destroying their vitality. 
Bacteriological research has shown that of this class of remedies 
copaiba alone possesses such power. To this drug must be added 
salol, which has been proved by laboratory and clinical tests to exert 
a powerful germicidal action upon the gonococcus. Cubebs is useful 
not because it has any specific action, but because it exerts a dis- 
tinctly modifying action upon the ardor urince, one of the most 
distressing symptoms of urethritis. A very admirable formula sug- 
gested by White is as follows : 

R. — Salol 5 to 10 grains. 

Oleoresin of cubebs ..... 5 grains. 
Para balsam of copaiba . . . .10 grains. 
Pepsin 1 grain. 

Encapsulate. Take one of these capsules six times daily. 

Beyond the capsules there is little need of medication by the 
stomach. Obstinate chordee may require bromide of potassium ; of 
this a drachm must be given at bed-time, and may be repeated in the 
night if painful erections persist. Lupulin in 30 grain doses is also 
indorsed. When practicable, opium or belladonna, suppositories or 
hypodermic injections of morphine gr. J and atropine gr. -^ into or 
about the perineum will prove more satisfactory. In all cases the 
patient should be instructed to rise once during the night and pass 
his water. 

Ardor urince is usually relieved by the use of cubebs, as in the 
capsule given above, by demulcent drinks, and by the employment 
of bicarbonate of sodium or citrate of potassium in sufficient doses to 
render the urine slightly alkaline. Either of these drugs is con- 
veniently administered in the form of compressed tablets taken one 
or two hours after meals in 10 grain doses, the quantity being 
increased, if necessary, until the desired effect is produced on the urine. 
The instillation into the urethra, by means of an eye-dropper, of a 
4 per cent, solution of cocaine a few minutes before urination 
markedly diminishes the burning. Finally, this symptom may often 
be relieved by instructing the patient to pass his water with the penis 
submerged in a vessel containing w T ater as hot as can be borne. 

Where the inflammation is of a high grade and attended by fever 
and general malaise, the administration of two drops of aconite 
repeated every two or three hours is followed by marked relief. 

In regard to the general treatment of a patient suffering from 
gonorrhceal urethritis, rest in bed is particularly desirable. This, 
however, is rarely possible, and the surgeon must be content with 
enforcing the avoidance of all active exertion and the observance 
of as much rest of mind and body as is compatible with a con- 
tinuance of the daily routine of business life. While skimmed milk 



GONORRHCEA. 443 

or buttermilk diet is theoretically desirable, the advantages to be 
gaiued by it are scarcely sufficient to justify iusistance upou such a 
regimen, especially as it would excite suspicion as to the presence of 
venereal disease ; hence a light diet consisting mainly of vegetables 
and fruits, and in quantity about half that usually taken, with a 
minimum amount of meat, should be advised. In addition the 
patient should be induced to drink liberally of plain water or any of 
the sparkling mineral waters, as by means of these the urine is not 
only rendered bland but greatly increased in quantity, thus enabling 
the urethra to be fully flushed from behind many times a day. 
Flooding of the stomach with such large quantities of liquids as to 
produce dyspepsia is distinctly to be avoided. It is scarcely neces- 
sary to state that copulation or any form of venereal excitement must 
be strictly interdicted. Finally, prolonged warm baths lasting from 
half an hour to two hours seem to exert a favorable influence upon 
the local inflammation. 

Acute posterior urethritis does not usually develop until the dis- 
ease of the penile portion of the urethra has run a course of two or 
three weeks. During the very acute symptoms local treatment 
applied to any portion of the urethral canal probably aggravates the 
condition, and even the internal administration of balsams and anti- 
septics must be employed with very great caution, being suspended 
at once if the inflammation seems to be aggravated by their employ- 
ment. Hence, when in the third week of gonorrhoea there is a 
violent outbreak of inflammation in the membranous and prostatic 
portions of the urethra, suspension of all active treatment is indicated. 
The bowels are kept open, the diet is carefully regulated, the urine 
is rendered bland and un irritating and antiseptic, continued warm 
baths are ordered, the painful symptoms being controlled by 
opium and belladonna administered either hypodermically or in the 
form of a suppository. When the acute symptoms subside the 
quantity of antiseptics taken by the mouth may be increased, 
balsams may be added, and local treatment may be directed, first 
to the posterior urethra, after the cure of which the anterior urethritis 
should receive attention. It has been already stated that injections 
forced into the meatus rarely penetrate beyond the bulbous portion 
of the urethra, hence to influence the deeper portions of this canal 
some other method of applying these drugs must be devised. This 
end is best accomplished by means of Ultzmann's irrigation catheter, 
or other instrument similar in principle. 

The patient is first instructed to empty the bladder of a portion of 
its contents ; by this means the urethra is flushed out. The cathe- 
ter is then introduced into the membranous portion of the canal 
and, by means of a syringe, 1 ounce of the injection is forced into 
the membranous and prostatic portions of the urethra. This fluid 
does not regurgitate along the sides of the catheter, but enters the 
bladder, and is passed with the urine at the next act of micturition. 



444 DISEASES. 

The injection most employed is the following : Nitrate of silver, 
grain \ to 1 ; distilled water, §j- Carbolic acid, 1 grain to the 
ounce, or any of the injections used in anterior urethritis, may also 
be used. These injections should be made twice a week. 



Chronic Gonorrhoea. 

Chronic gonorrhoea differs from the acute form in the fact that 
the inflammation is distinctly localized in certain portions of the 
urethra and does not invade the whole canal with uniform intensity ; 
hence, efficient treatment must be directed not to the whole urethra 
but to the diseased areas. Foci of chronic urethritis are usually 
found either in the bulbous portion of the urethra or in the mem- 
branous or prostatic portions. If the disease is located in the ante- 
rior urethra it will commonly be found to depend upon the existence 
of a stricture of large calibre. The passage of sounds of full size, 
cutting the meatus if this is necessary for their introduction, will, in 
such cases, be followed by prompt relief. The sounds should be used 
not more frequently than twice a week, and should be most carefully 
sterilized before introduction. 

If after free dilatation the discharge still persists, and a large por- 
tion of the anterior urethra is in a catarrhal condition, as shown by 
examination of the urine, irrigation of the urethra should be prac- 
tised. This may be best effected by passing a soft rubber catheter 
down to the membranous portion of the urethra and injecting 
through it once daily 3 ounces of a half-grain-to-the-ounce solution of 
nitrate of silver. When the general catarrhal condition is mate- 
rially modified, by means of an ordinary hard-rubber endoscope and 
a head mirror the focus of inflammation may be exposed, and may 
be treated directly by strong astringent solutions carried in by means 
of a brush or by absorbent cotton secured to the extremity of a long 
applicator. Nitrate of silver or sulphate of copper, twenty grains to 
the ounce, may be employed. Unna has devised a most successful 
treatment for obstinate cases of gonorrhoea. He advises coating the 
sounds with the following mixture : 

R.— 01. cocse ^iij. 

Cerse flav ^ss. 

Argent, nit. . . . . . . . gr. xv. 

Bals. Peruvian £ss. 

This is liquefied in a water-bath, the sounds are dipped in it and 
are then hung up to dry. On being passed the heat of the body 
melts the coating. The objection to their use lies in the fact that the 
application is made to the entire urethra. Practically, however, 
their employment is often followed by brilliant results. 



CHRONIC GONORRHOEA. 445 

Chronic posterior urethritis must be treated by remedies applied 
directly to the diseased area. Nitrate of silver is more commonly 
successful than any other medication. By means of Ultzmann's 
apparatus three or four drops of a solution varying in strength from 
0.1 per cent, to 5 per cent, may be employed. 

Finger recommends the following ointment : 

R. — Argent, nit. or cupri sulph. . . . . . s;r. xv. 

Lanolin . . . . . . . . . ^iij. 

01. olivse ......... 3Jss. 

By means of an ordinary catheter, which is first filled then intro- 
duced until its eye reaches the prostatic portion of the urethra, a 
definite quantity of the ointment can be forced into the canal by a 
graduated rod. 

In many cases pressure will exert a curative action, causing prompt 
absorption of inflammatory effusion. To accomplish this result large 
sounds may be passed into the bladder. Frequently the thera- 
peutic influences of cold together with pressure are found beneficial. 
The best means of combining these two remedies is found in the 
psychrophor, an instrument in the shape of a sound but so arranged 
that a stream of water flows through its interior. 

It must be borne in mind that chronic gonorrhoea is commonly 
due to unskilful or not sufficiently prolonged treatment of the acute 
stages. 'Not only should the treatment of acute gonorrhoea be con- 
tinued until the gonococci have entirely vanished, but for fully two 
weeks after the disappearance of all symptoms of inflammation. 
The same rule holds good in regard to the chronic manifestations of the 
disease. Only after careful examination of the urine fails to show 
any sign of inflammatory trouble for at least two weeks should the 
treatment be suspended, and this should not take place suddenly, the 
intervals between the applications being gradually increased, the 
patient being carefully watched in the meantime. 

Per contra, it must not be forgotten that long-continued irritant 
... . 

treatment may in itself indefinitely prolong a urethral discharge. 

Hence it is wise to suspend all injections in certain cases, and to ex- 
amine the discharge carefully, as found in the urine, to determine 
whether or not the continuance of symptoms is dependent upon this 
cause. 

There is a mucous secretion which quite frequently follows gonor- 
rhoea but which is in no way dependent upon the persistence of this 
disease. Microscopic examination will at once determine its nature. 
It is probably most rapidly cured by attention to general hygiene 
and by tonic and supporting treatment. 



446 DISEASES. 



Complications of Gonorrhoea. 

Among the many local and general complications which may occur 
in the course of an acute or subacute gonorrhoea are balanitis, balano- 
posthitis, prostatitis, and epididymitis. 

Balanitis and balano-posthitis are treated by perfect cleanliness. 
The discharge must be thoroughly washed out, the surface must be 
dried and must be isolated. The thorough cleansing of the parts is 
best accomplished by weak astringent solutions, such as the chloride 
of zinc, 4 grains to the ounce, 1 per cent, boric acid, or 1.5 per cent, 
carbolic acid ; nitrate of silver is particularly valuable, if used in 
the form of a wash or injection 1 grain to the ounce will be found 
sufficiently strong. The superficial ulcerations may be further 
touched with the solid stick of the nitrate of silver. The prepuce 
having been retracted and the parts having been thoroughly washed, 
dusting powder, such as tannin or oxide of zinc, is distributed over 
the surface of the inflamed parts; the glans is then covered with 
a thin layer of absorbent cotton, and the prepuce is drawn forward. 
This dressing is to be repeated three times daily. 

If the phimosis is so tight that the prepuce cannot be retracted, 
cleansing astringent injections and wrapping the penis in one or two 
thicknesses of gauze or other thin fabric, constantly kept wet with 
dilute lead-water, will be the treatment indicated. If, in spite of 
this treatment, inflammatory symptoms become more marked, circum- 
cision is indicated. 

Prostatitis rarely develops before the second or third week of 
urethritis. Where the acute symptoms are fairly developed direct 
local treatment is of little avail. Rest in bed, light diet, careful 
regulation of the bowels, medication to render the urine bland and 
nnirritating, elevation of the pelvis, local depletion by means of 
leeches applied to the perineum, and the administration of morphine 
and belladonna, either by means of suppository or by hypodermic 
injection, represent the general treatment of all inflammatory condi- 
tions at or about the neck of the bladder. In the great majority ol 
cases prostatitis undergoes prompt resolution, and this is more power- 
fully influenced by rectal injections than by any other method of 
treatment. For this purpose a two-way rectal tube must be employed, 
the nozzle of which is directed against the projection of the prostate 
into the bowel. From 2 to 4 quarts of water, either very cold or 
as hot as can be borne, are allowed to flow into the rectum by gravity 
this arrangement of the tubes allowing the injection to flow out as 
rapidly as it flows in. This treatment should be repeated three or 
four times a day. When, in spite of careful treatment and the free 
use of anodynes and antispasmodics, there is retention of urine, a soft 
catheter should be passed into the bladder and allowed to remain 
there. 



COMPLICATIONS OF GONORRHOEA. 447 

If general and local symptoms denote abscess formation, the pus 
should be evacuated by perineal incision as soon as its presence is 
positively determined upon. It is true that the pus collection usually 
is spontaneously discharged into the urethra, but this result cannot 
certainly be depended upon, and, at best, is an unsatisfactory termi- 
nation of the trouble. When the inflammation runs into a chronic 
type the treatment suitable for chronic posterior urethritis is indicated, 
namely, the use of large, cold, steel sounds and local applications to 
the prostatic urethra. In addition rectal injections, by means of the 
two-way tube, are very efficient in producing a cure. 

Epididymitis requires rest in bed, cessation of all local treatment 
directed against the gonorrhoea, the elevation of the pelvis and testicles, 
and the systemic treatment applicable to acute inflammation. The 
general tendency of this complication of gonorrhoea is toward spon- 
taneous resolution. The testicles may be supported by a handker- 
chief bandage, the base of which is passed beneath the scrotum 
while the ends and apex are secured in front to a circular band pass- 
ing about the waist. To combat the agonizing pain and hasten the 
cure punctures have been advised. These, by relieving tension, 
promptly alleviate the suffering. Ice-bags may also be applied, 
though it is claimed that as a result of this treatment there remains 
an obstinate induration of the epididymis. Local applications of 
the nitrate of silver and of tincture of iodine are also said to act 
beneficially. 

Since it is usually impossible for a patient suffering from gonor- 
rhoeal epididymitis to keep to his bed, a treatment must be advised 
which will allow him to attend to his business and at the same 
time will prevent the inflammation from becoming aggravated. 
The part must be splinted ; if at the same time uniform pressure 
can be applied the cause of the trouble will be still further favor- 
ably modified. These indications are complied with, partially at 
least, by strapping the injured testicle. For this a number of adhe- 
sive resin strips, each half an inch wide and long enough to pass 
three-fourths around the swelled testicle are cut. The first strip 
encircles the scrotum between the affected testicle and the body, 
tightly imprisoning the former in a pouch of skin. The succeed- 
ing strips are then placed each overlapping the other in such a 
manner that the entire pouch is covered in, and a handkerchief 
bandage, applied as described above, may then be used to elevate the 
testicle. A better means of securing rest and pressure and at the 
same time exerting the resolvent influences of heat and moisture, is 
offered in the dressing proposed by Horand-Langlebert. The entire 
scrotum is first enveloped in a thick layer of cotton ; over this is 
placed a piece of rubber-dam sufficiently large to cover in the cotton, 
and the dressing is completed by an ordinary suspensory, gored at the 
sides and provided with tapes to allow of close fitting. Unless there 
be decided swelling of the spermatic cord this dressing usually allows 



448 DISEASES. 

the patient to attend to his business and is followed by as prompt 
resolution as though confinement to bed had been insisted upon. 
When the acute symptoms have disappeared attention must be 
directed to the removal of infiltration, which if it persists may be 
a cause of sterility. This is accomplished by the continuance of 
heat, moisture, and pressure ; by local applications, such as iodine 
gr. iv in lanolin §j, or of equal parts of mercury ointment and bella- 
donna ointment, and by the internal administration of iodide of 
potassium, 10 to 20 grains three times daily. 



Gonorrhoea in the Female. 

The symptoms of acute gonorrhoea in the female are usually so 
mild that the attention of the physician is rarely called to the disease 
until it has reached its chronic form and has invaded the uterus and 
its appendages. When, however, acute urethritis is found, the 
treatment both local and general is conducted on the same princi- 
ples as when the disease attacks the male urethra. During the most 
acute stage no local treatment is advisable, subsequently injections 
can be made with the ordinary clap syringe, not more than a drachm 
and a half of the liquid being employed at a time. If the urethral 
discharge persists, the seats of the suppuration are readily found by 
the endoscope tubes and treated directly by applications of strong 
solutions of nitrate of silver or sulphate of copper. The results of 
treatment are commonly satisfactory. 

Acute vaginitis is, in actual practice, not very frequently observed. 
In addition to the general treatment of inflammation, local treatment 
directed to cleansing thoroughly the inflamed surfaces of discharge 
and acting upon them by a strong antiseptic lotion, will be followed 
by a rapid cure. The patient is instructed to irrigate the vagina three 
times daily with two pints of bichloride of mercury solution, 1 to 
4000, thrown in by means of a fountain syringe. For this fluid to 
reach every portion of the diseased mucous membrane, it is necessary 
that the patient should lie upon her back with the hips elevated. 
Before rising, a pledget of absorbent cotton is placed between the 
labia. During the most acute stage of vaginitis hot-water injections 
and prolonged hot sitz baths are indicated. In addition to the anti- 
septic irrigations which the patient is directed to make, the physician 
should every second day insert a speculum and paint every portion 
of the diseased mucous membrane with nitrate of silver solution, 
varying in strength from 4 to 40 grains to the ounce. The vagina 
should then be packed with tampons of absorbent cotton, which may 
be dusted with astringent medication. 

Vulvitis corresponds to balanitis in the male and is treated in a 
similar manner. Cleanliness is the most essential point in securing 



gout. 449 

a cure. The parts are thoroughly washed with weak antiseptic 
lotions, and the abraded mucous surfaces are kept from coming in 
contact by means of a layer of absorbent cotton, or a piece of lint 
soaked in dilute lead-water or other mild astringent solution. 



GOUT. 

Gout is a word used to signify a series of manifestations occurring 
chiefly in those who have led a lazy, sluggish life, and have lived on 
the fat of the land and partaken more frequently of alcoholic bever- 
ages than of water, or it occurs in persons who do not live in 
this way but whose ancestors will be found to have done so, and 
to have handed down to them the gouty taint or diathesis, or, once 
more, in those who have had poor food for a long time. Very few 
Americans have gout in its marked and characteristic forms, owing 
to the active life pursued and to the fact that the inhabitants of the 
Western Hemisphere drink large amounts of water, thereby continu- 
ally dissolving any effete matters in the system and washing them 
away. 

The importance of pure water in this state is therapeutically 
remarkable, and the so-called lithia waters depend for their value 
more upon their freedom from salts than their presence. When a 
patient goes to medicinal springs he simply acts as a sluice-way, and, 
by continually drinking water, washes out the kidneys and prevents 
deposits of calcareous matters throughout the body. In a gouty 
individual the liquids of the body may be said to be so overladen 
with salts that they deposit them wherever a spot is found which is 
easy of access, just as water laden with lime forms a deposit on the 
sides of its bed when a drought comes on, and dissolves and removes 
these formations when a freshet takes place. Very often, when such 
waters are not attainable, satisfactory results will be reached by ordi- 
nary distilled water, the insipid taste of which can be overcome by 
charging it with carbonic acid. 

When an acute attack of gout comes on, it is generally situated, 
as is well known, in the joints of the big toe or other toes, but may 
involve any part of the body, even to the heart and the contents of 
the abdomen. By far the best remedy for the relief of the pain is 
morphine, which should be given hypodermically, some persons say 
as near the spot involved as possible. At the same time the best 
remedy for gout that we have, colchicum, should be freely given 
until the patient shows evidence of the full effect of the drug, as 
evidenced by gastro-intestinal discomfort or pain and slight laxity of 
the bowels. The drug should be used in the form of the wine of 
the root, not the seeds, in the dose of 20 drops at the start, and 
increased by one drop every four hours until relief is obtained or 

29 



450 DISEASES. 

symptoms of poisoning appear as noted above. In using this drug 
it is important to remember that retrocedent gout is more apt to occur 
under its influence than in an attack where the drug is not used. 
That is to say, the inflammation in the great toe may suddenly dis- 
appear, only to break forth in a violent and almost always fatal 
entero-colitis, gastritis, cerebritis, or heart- failure. Any condition of 
intestinal irritation or diarrhoea predisposes to such a complication 
very commonly under the use of colchicum. 

The local treatment of gout, when it is active, consists in the 
application of a number of much vaunted but frequently useless 
remedies. For hospital practice a very useful mixture is made by 
adding one part of bicarbonate of sodium to nine parts of linseed oil, 
and wrapping the joint involved in a piece of lint soaked with this 
concoction. In other cases collodion may be applied in one or two 
good coats, not more, with relief, and in still others oil of pepper- 
mint has been recommended. It is to be remembered, however, that 
the inflamed joints are not to be treated by depletion through leeches 
or bleeding, as by this means they ultimately become worse ; or, in 
other w T ords, the treatment of gouty inflamed joints is not identical 
with that of inflamed joints from other causes. When the pains of 
acute gout are very severe at night, potassium iodide, in the dose of 
15 grains at four or five o'clock in the afternoon, will sometimes 
give relief; this drug should always be combined with colchicum if 
the disease is subacute or chronic. 

In chronic gout, except during the acute exacerbations of the dis- 
ease, colchicum is almost useless, but potassium iodide should be 
pushed to the point of iodism, if the trouble be painful. Here diet 
comes in for a great part of the treatment, and should consist of 
foods which are not fatty nor rich, but plain and nourishing. Milk 
and eggs, the white meat of chicken, and cooked fruits without sugar 
being added, are allowed, tea and coffee being used only in modera- 
tion. If any wine is taken, it must be followed by copious draughts 
of pure water, and this last article should be used ad libitum. On 
the other hand, pastries, aud, more than all, sweet wine, are the worst 
things that such a patient can take, and must be absolutely pro- 
hibited. 

The insomnia of chronic or subacute gout is best put aside by 
potassium bromide and chloral, the former drug being the safest and 
best. 

The local treatment of chronic gout consists in the application of 
flying blisters at a little distance from the suffering joint every few 
days. Where the deposit around the joints is very great and the 
normal movements are impossible, relief is often obtained by the 
application of a solution of citrate or carbonate of lithia, 5 to 10 
grains to the ounce of water, on lint around the parts. Where the 
skin is broken and will not heal, this treatment often permits heal- 
ing by dissolving the crystals in the wound which prevent the 



GRANULAR LIDS. 451 

approximation of the edges and so cause irritation. Iodine oint- 
ment or the tincture of iodine is often placed around chronic gouty 
joints with advantage. 

A standard remedy in subacute or chronic gout is arsenic, and its 
administration in the form of 3 drops of Fowler's solution, either 
with perfectly pure or lithiated water, is always to be resorted to. 
If anaemia is present arsenic is particularly indicated, and cod- liver 
oil and syrup of the iodide of iron are also of value in this state. 

We find, therefore, in conclusion, that the use of large amounts of 
pure water devoid of salts, colchicum, potassium iodide, and arsenic 
are the greater points about which the rest of our treatment should 
centre. In those cases where retrocedent gout comes on, the heart 
must be supported by stimulants, particularly by hypodermic injec- 
tions of ether until the slower drugs can act, by heat over the belly, 
by the use of opium to allay irritation, except where the brain and 
kidneys are seriously affected, and by the use of diuretics and alka- 
line drinks, and finally by counter-irritation in the shape of a mustard 
plaster placed over the abdomen or chest as the case may be. 



GRANULAR LIDS. 

This disease may be divided into acute and chronic granulations. 
In the former astringents and caustics are inadvisable, the eyes 
requiring weak antiseptic solutions like boric acid or salicylic acid, 
and the instillation of atropine. Leeches to the temple will aid in 
reducing the inflammatory reaction. In the chronic disease the object 
of treatment is to bring about absorption of the granulations which 
are its characteristic lesion, not by an application so caustic as to 
destroy the mucous membrane around them, but of sufficient vigor 
to produce healthy reaction. The following applications comprise 
those which have been employed with the greatest success : 10 grain 
solution of nitrate of silver, if there is discharge, applied once a day 
with neutralization of the excess ; sulphate of copper in the form of 
a crystal carefully applied to the everted lids and the retrotarsal folds ; 
pure carbolic acid applied with a camel's-hair pencil and the excess 
washed away with water ; glycerole of tannin (tannic acid gr. 30, 
glycerin 1 oz.) best applied with a cotton applicator ; boro-glyceride 
from 20 to 50 per cent., according to the vigor of the granulations. 
Strong solutions of corrosive sublimate are employed in the fol- 
lowing manner : solutions of the strength of 2 to 200 or 1 to 500 are 
painted on the everted lids every second day, the pain of the appli- 
cation being alleviated by the previous instillation of cocaine, while 
three times daily the eyes are irrigated thoroughly with a solution of 
the mercury salt 1 to 7000. The surgical means which are employed 
to destroy the granulations are scarification of the conjunctiva, an 



452 DISEASES. 

inadvisable method ; excision of the granulations, useful if these 
exist in isolated groups ; crushing the granulations with specially 
devised forceps, a method often followed by satisfactory results ; and 
excision of the fornix conjunctiva. In long-standing cases associated 
with inveterate pannus, de Wecker has proposed the use of an infu- 
sion of jequirity (3 per cent.). This produces an intense membranous 
conjunctivitis, which must be treated by iced compresses or similar 
measures to reduce its reaction, but when it has subsided the pannus 
is often relieved. This method has not been employed in recent 
times to the extent that it was practised when first introduced. 



HEADACHE. 

(For Neuralgic Headaches, see Neuralgia. For Bilious Head- 
ache, see Biliousness.) 

Probably no single source of pain compares in its frequency to 
headache, chiefly because it is essentially a mere symptom of a dis- 
ease and nothing more. It may arise from eye-strain, from brain 
disease, from anaemia, from plethora, from nervous breakdown, and 
from a multitude of causes which, if they were all recounted, would 
cover many pages of this book. The only forms of headache w r hich 
will be considered here are those due to congestion or from fatigue. 

Congestive headaches, dependent upon an engorgement of the cere- 
bral vessels with blood, are to be treated in a number of ways, and 
if any direct cause can be discovered this must of course be removed. 
So far as the direct application of drugs is concerned we find two 
methods of promoting a cure. The first consists in the use of ergot, 
which will cause contraction of the dilated vessels, the second in the 
employment of vascular sedatives which will produce arterial depres- 
sion and so remove congestion. Sometimes one of these methods 
will succeed where the other fails, and it is almost impossible to tell, 
beforehand, which case should have one drug and which another. 
It is to be remembered that when the congestion is due to vascular 
relaxation and weakness the vascular sedatives are contra-indicated. 

The use of a hot mustard foot-bath is of great value, and a mustard 
plaster or cup applied to the nape of the neck is often of service in 
congestive headaches. 

Where headache depends upon fatigue, either general or local, 
stimulating treatment is necessary. If eye-strain be the cause, full 
doses of strychnine or nux vomica are of service, and in many 
instances a combination of caffeine, bromide of sodium, and antipyrine 
is very successful, as follows : 

R. — Caffeine citrat , . gr. xl . 

Sod. bromid. gi v. 

Antipyrine . . . . . . . gij. 

M. — Ft. in chart. No. xx. S. One powder in water as needed. 



HEART DISEASE. 453 

Sometimes the caffeine makes the headache more acute, and if this 
occurs only the antipyrine can be used. 

Sleep is generally a more useful prescription than any drug, and 
if business creates so much mental anxiety during the day as to be 
wearing upon the nervous system, or make the patient wakeful at 
night, business must be put aside and health and recreation sought 
after at a watering-place. Horseback exercise is very useful indeed, 
and should be resorted to by all who can afford it if they are suf- 
ferers from nervous headaches. 



HEART DISEASE. 

(For Treatment of Angina Pectoris, see p. 347.) 

The writer classifies all forms of heart disease under this heading 
advisedly. In valvular disease the profession are beginning to 
understand more and more that the mere destruction or laming of 
this valve or that has little to do with the treatment, although the ulti- 
mate result of the case is somewhat dependent upon these conditions. 
It matters not whether the leak in a valve be minute or huge, pro- 
vided the heart can still do its work ; the condition of cardiac muscle 
is the important factor in the question. If an irreparable leak exists 
in a pump the question is not can we cure that leak, but can we work 
the pump with enough force and rapidity to obtain all the water 
needed for the maintenance of life. Some physicians use heart tonics, 
such as digitalis, whenever they find a valve diseased, as if to mend 
the broken valve. Nothing can be more erroneous, for a valve 
once injured is never healed. 

It should be an invariable rule with every physician in examining 
a patient with heart disease to determine whether or not the tissues 
of the body receive their normal blood-supply. If they do not, even 
though the leak is so small as to escape notice, digitalis is to be used ; 
but even if the murmur heard on auscultation is as loud as that of 
a machine-shop and the tissues are not starved no remedy is needed. 

Another very important point in regard to the treatment of cardiac 
disease in children, is the remembrance that the stunting of the body 
and the slowness of growth are not merely the result of heart trouble, 
whereby the tissues do not increase in size from lack of nourishment, 
but occurs for a special purpose. Supposing that a child of eight or 
nine years has scarlet fever or rheumatism, which leaves the cardiac 
valves impaired in function. For a few days, or hours at least, the 
question must arise in the heart : " Can I fill all the bloodvessels 
properly ?" If it can supply the vessels the child lives, but is stunted 
because nature is wise enough to understand that the struggling 
heart has all it can do to supply even a stunted frame, and realizes 



454 DISEASES. 

that an increasing area of bloodvessel surface in a growing child 
would exhaust the cardiac muscle. 

The physician should not endeavor to make a child grow by 
exercise or tonics, but should direct his attention to the care of the 
general health, and particularly that of the heart, for as soon as this 
organ is strong enough to permit of growth, growth will take place. 

Having made these preliminary remarks, let ns turn to the direct 
application of drugs to heart disease, the chief drug in the list being, 
of course, digitalis. 

The value of the digitalis may be said to rest upon a number of 
influences possessed by it. In the first place, evidence is constantly 
accumulating to show that digitalis increases the nutrition of the 
heart muscle by the stimulating influence which it exerts over the 
pneumogastric nerve ; this nerve having been partly proved to be a 
trophic nerve of the heart. Aside from any such nervous influence 
the heart muscle, under the use of digitalis, receives a greater blood 
supply, since both diastole and systole are influenced by the drug, 
the systole being more complete and the diastole being prolonged and 
more extensive. 

Two theories concerning the nutrition of the heart muscle through 
its blood supply have been promulgated. One is that the coronary 
arteries are filled with arterial blood as the heart drives its contents 
out of the left ventricle, or, in other words, during systole. The 
other hypothesis rests upon the belief that the contracting muscle 
prevents a free circulation of blood through the cardiac bloodvessels, 
and that the blood is driven into the coronary arteries during diastole 
by the pressure in the aorta, the aortic valves being closed. In the 
belief of the author both of these theories are partly true. That is 
to say, the coronary arteries are filled during ventricular systole, 
according to the first theory, but the complete passage of the blood 
through the smaller vessels of the cardiac muscle only takes place as 
relaxation or diastole occurs. The ground for this belief consists in 
the observation that a muscle when firmly contracted always presses 
upon its supplying bloodvessels, and particularly interferes with 
capillary flow. The heart of one of the lower animals, if carefully 
watched after the chest-wall is removed, will always be found to be- 
come paler during systole and redder during diastole, and if wounded 
will bleed more freely during the relaxing period than during the 
contraction of its fibres. As the blood everywhere in the body nour- 
ishes the tissues, not when in the arteries, but while passing through 
the capillaries, it would seem self-evident that while the coronary 
arteries are filled by the systole or contraction of the heart, the nutri- 
tive changes and perfect capillary circulation go on during diastole. 
If these things are true the increase in cardiac nutrition and growth 
under the action of digitalis is only what one would expect, for we 
have learnt when studying this drug that it prolongs diastole and 
increases the force and volume of the systolic wave of blood. In 



HEART DISEASE. 455 

other words, digitalis fills the coronary arteries almost to bursting, 
and so when diastole occurs not only floods the cardiac capillaries 
with blood but prolongs the period during which the interchange 
between the blood-stream and tissues takes place. 

There is still one other way in which digitalis does good in cardiac 
disease by its peculiar powers. Normally, the heart beats fast and 
slow according to the demands made upon it by the system for blood, 
and its action is varied by the calls which it receives from the tissues. 
In heart disease, owing to the leaky valves, the tissues are starved, 
and continually send messages for more nourishment to the cardiac 
muscle, which finally becomes exhausted by its endeavors to supply 
their wants, and beats now fast and now slow, uncertain what to do. 
If digitalis is given the vagi render the cardiac action regular and 
effective, and act as regulators and directors of its energies, thereby 
supplying the tissues and using the remaining power of the heart to 
the greatest advantage, in addition to improving its blood supply by 
the methods already described. The starving tissues of the body 
having been satisfied, as Dr. H. C. Wood has eloquently ex- 
pressed it, "the angry messengers from the periphery cease their 
callings and the heart is at peace and in comfort." 

From what has been said it becomes evident that this drug, digi- 
talis, does good whenever the heart is weak or unable to supply the 
body with blood, and we find for this reason that cardiac dilatation, 
simple cardiac failure, or failure dependent upon poisons, all indi- 
cate its use. 

The mechanism of the action of digitalis in the different cardiac 
lesions still remains to be described. 

Taking up the most common condition, that of mitral regurgita- 
tion, we find that in this disease the blood passes in its normal flow 
from the auricle into the ventricle, and when the ventricle is filled that 
the cardiac muscle contracts on all sides equally. Normally the mitral 
valves close the auriculo-ventricular opening and prevent any of the 
blood from regurgitating back into the auricle, and the greater the 
pressure the tighter they become. Abnormally the blood is still 
pressed upon on all sides as before, and trying to escape, as do all 
liquids, from pressure, finds that owing to disease of these valves it 
can, in part at least, slip back into the auricle from which it came, 
rather than pass out into the high pressure of the arterial system. 
The ventricle, therefore, propels blood in two directions, one the 
wrong way and one the right way. If the leak is big enough to 
carry off more blood than the aorta then death occurs. Digitalis 
under these circumstances does good, because by increasing the force 
of the ventricle it increases the friction at both the mitral leak and 
the aortic opening ; as the aorta is a large opening and the mitral 
leak a small one, the greater quantity passes out in the circulation. 
The same point arises for consideration as before, namely, that it is 
not the amount of leak but the amount of supply to take its place, 



456 DISEASES. 

which is the vital question in the case. Sometimes relief does not 
occur and the patient is made worse by digitalis, because the leak 
is increased as much as the normal flow. 

In mitral obstruction the difficulty is that the blood cannot enter 
the ventricle with sufficient rapidity, and this part of the heart con- 
tracts before it is well filled. By the prolongation of diastole the 
blood is given sufficient time to enter, and the ventricle is filled, 
sending out into the system a large wave of blood when it contracts. 

In aortic stenosis there is obstruction to the normal flow of blood 
out of the heart, and the digitalis is needed to increase the ventricular 
force so that it may overcome the difficulty. 

In aortic regurgitation digitalis, by its stimulation of the heart, 
may cause a sufficient output of force to clear itself of the regurgi- 
tant flow, but in most cases the drug fails, because the prolongation 
of diastole gives so much more time for the blood to flow backward 
in the dilating ventricle. The cardiac remedies to be used in such 
cases are strophauthus, in the form of the tincture, dose 3 to 5 drops, 
adonidine, dose \ to \ grain, or sparteine, \ grain. These remedies 
may also be used in the other forms of cardiac disease where digitalis 
fails. 

In cardiac dropsy digitalis and the other heart stimulants do good 
by raising blood pressure and pulse force. (See Dropsy, page 399.) 

In cardiac palpitation dependent upon indigestion, this condition 
must be relieved by appropriate digestive remedies, but in that form 
of palpitation due to over-exertion or heart strain, digitalis is useful. 
Sometimes aconite or veratrum viride are very serviceable in palpita- 
tion if the cardiac condition is good, and iron is to be used if the 
irritability be due to ausemia. Tea, coffee, tobacco, and excessive 
venery are to be forbidden. Sometimes nux vomica does good by 
stimulating the heart and nervous system, and belladonna seems of 
great value where arhythmia is present. Ringer recommends the 
use of veratrine ointment over the prsecordium in some of these cases. 

In sudden cardiac failure, from weakness or poisons, the use of 
ether and ammonia is to be resorted to at once, and these are to be 
followed by alcohol and digitalis, if necessary. The ammonia is a 
direct heart stimulant, as is also the alcohol and ether. 

Cardiac hypertrophy is rarely seen alone without some other lesion 
accompanying it, but it may occur from prolonged and excessive 
exercise or other cause. It is to be treated by aconite, veratrum 
viride, perfect rest, and avoidance of exercise, and in the use of 
moderate amounts of food of a non-stimulating character. Wines 
and coffee should be forbidden, and veratrine ointment placed over 
the heart. 

Fatty heart occurs in two forms. That in which true fatty de- 
generation has taken place in the muscular fibre, and that in which 
there is a deposit of fat between the fibres. Nothing of any moment 
can be done for the first state, but much for the second. The patient 



HAEMORRHAGE. 457 

suffering from this latter form of heart trouble is nearly always obese, 
and should suffer abstinence from fats and rich foods, from all sweet 
wines or malt liquors, from sugars and milk, and, at the same time, 
take exercise. At first this treatment may cause dyspnoea, but by 
increasing the severity of the exercise by a small amount daily great 
feats can generally be effected in the end, with marked improvement 
in the cardiac action. 



HEMORRHAGE. 

{Including Menorrhagia, Metrorrhagia, Haemoptysis, Hcematemesis, 
Intestinal Hemorrhage, Hematuria, and Post-partum Haemorrhage.) 

Under this heading will be taken up the consideration of all forms 
of haemorrhage which can be controlled by drugs or measures not 
distinctly surgical in their scope, with the exception of epistaxis, 
which has already been spoken of. 

Whenever a haemorrhage can be arrested by the application of a 
ligature or compression, as in a cut finger or some similar wound, no 
styptic should be used. Styptics are employed for the double purpose 
of constringing the tissues and coagulating the blood, and, in conse- 
quence, form coagula w 7 hich make a nasty septic mass about the 
Avound. In their place the physician should resort to a compress 
soaked in some antiseptic liquid, or filled with disinfectant powder, 
and if this fails to control the bleeding then ligation of the bleeding 
vessel becomes necessary. 

Where the bleeding point cannot be reached by direct compression 
or for ligation, the use of packing and of astringents is advisable, and 
drugs which are anti-hasmorrhagic should be used by the mouth. As 
these forms of haemorrhage are generally given separate names, they 
will be so considered. 

Menorrhagia is an excessive flow of menstrual blood, either excess- 
ive in quantity during two or three days, or prolonging itself over an 
unusual number of days, while metrorrhagia is a state in which bleed- 
ing takes place from the uterus' independent of menstruation and at 
any period of the month, or even after the menopause has occurred. 

Menorrhagia or excessive menstruation is not to be judged by the 
amount of the flow but by the question as to whether the loss is suffi- 
cient to cause decrease of health or to indicate disease. In some cases 
it is a means of relieving plethora. 

When the physician decides that something should be done to 
remedy the condition of the patient, either in menorrhagia or met- 
rorrhagia it will be necessary for him to find out whether any polypi 
or other form of uterine disease is directly responsible for the trouble, 
and in the meantime to employ drugs known to act favorably upon 
uterine haemorrhage. The most prominent of these drugs are ergot 



458 DISEASES. 

and oil of erigeron, the first being more active and the best remedy 
for active bleeding, the second the better for oozing and the presence 
of a continual " show." 

The fluid extract of ergot may be given in varying dose, from 10 
to 60 drops according to the necessities of the case, and the oil of 
erigeron in capsules in the dose of from 8 to 5 minims, or if capsules 
cannot be had the physician must employ the oil in an emulsion 
made by using syrup of acacia or other similar substance. 

Where menstruation is irregular and the menorrhagia is almost a 
metrorrhagia, bromide of potassium or sodium in the dose of 10 grains 
once or twice a day is often very serviceable indeed, and the distilled 
extract of hamamelis in the dose of 1 drachm three times a day is 
almost as useful. Cannabis indica, if an active sample is obtainable, 
is also said to be of service, but the writer has never seen it used. 
Oil of cinnamon in the dose of J drachm is very efficacious in the 
slow oozing of some cases where erigeron cannot be used or obtained. 
Sometimes, where congestion of the pelvic viscera is the cause of the 
trouble dry cups over the sacrum give relief. 

Haemoptysis, or haemorrhage from the lung, is nearly always due to 
tubercular ulceration of a small or large bloodvessel, and the life of 
the patient depends in reality more upon the rapidity with which a 
clot naturally forms, than upon any skill of the physician. Though 
textbooks order atomized solutions to be inhaled and other remedies 
to be taken by way of the lung, in most cases these measures will be 
found impracticable, simply because the nervousness of the patient 
and the constant cough will not permit of inhalations of any extent, 
and even if a full breath can be taken it generally increases the bleed- 
ing and coughing. The only occasions on which inhalations of 
styptics are of service are those in which the haemorrhage is just 
beginning, or so slight as to streak the sputum or to be at least 
thoroughly mixed with it. The solutions to be so employed must 
be used in an atomizer which will throw a fine spray, sufficiently fine 
to enter the smallest air-tubes with the inspiratory wave of air. A 
very good fluid is one made from MonsePs solution as follows : 

R. — Liquor ferri subsulphat. £tt xx to xxx. 

Aq. dest f ^ iv. 

M. — S. Use in an atomizer every few minutes. 

Or the following : l 

R. — Acid, tannic . gr. xx. 

Glycerin. . . . . . . . . fsjij. 

Aq. dest. q. s. fjiij. 

M. — S. Use in atomizer. 



1 If the Monsel does not stop the haemorrhage, the tannic acid will probably fail, but 
more important still, the two should not be used together, as the tannate of iron is as 
black as ink. 



H^EMOKRHAGE. 459 

Or, 

R. — Aluminis . . . . . • . . . gr. vj. 

Aq. dest. . . . . . . . . fjfiij. 

M. — S. Use in an atomizer. 

At the same time the patient should swallow, whether the haemor- 
rhage be acute or not, not less than 1 to 1 J drachms of the fluid 
extract of ergot, or a solution made by adding 20 grains of gallic 
acid to 1 ounce of water. To allay nervous excitement a hypodermic 
of morphine should be used. 

Sometimes the patient can point directly to the spot where the 
haemorrhage exists, and under these circumstances a dry cup or a 
piece of ice placed over this point will prove useful. 

After an attack of haemoptysis there is great danger in many cases 
of a traumatic pneumonia being set up by the presence of the ex- 
travasated blood. This should be combated by the use of a careful 
diet, the reduction of any arterial excitement, and by small doses of 
aconite in persons not weakened by advanced disease or bleeding. 
Perfect rest in bed is to be insisted on and no stimulants allowed in 
food or drink, unless the weakness of the patient requires it. 

Hcematemesis. — This depends either upon some injury to the stom- 
ach or much more commonly upon gastric ulcer, cancer, or some 
other severe form of gastric trouble, and is one of the easiest of the 
so-called "internal haemorrhages" to treat, because by swallowing 
drugs they can act directly upon the bleeding surface. 1 In such a 
case small pieces of ice should be swallowed frequently, and this may 
be assisted by 3 drops of MonsePs solution in a half tumblerful of 
water every fifteen minutes. Tannic acid may be given instead in 
the dose of 20 grains to the drachm, but the two should never be 
given at once to the same case. (See foot-note on page 458.) Mou- 
sed s salt may be given in pill in the dose of 2 to 3 grains. The 
acetate of lead is also of value in pill form with morphine or opium 
in the dose of 2 to 3 grains. Tincture of the chloride of iron, the 
sulphate of iron, turpentine, ipecac, ergot, and hamamelis may all 
be used, the last three particularly in slow or passive haemorrhages. 
Sometimes nitrate of silver in the dose of J of a grain in pill form 
is of service if the haemorrhage is slow. 

Hcemorrhage from the bowel is to be treated according to its 
point of origin. If in the small intestine, as from ulceration of 
Peyer's patches or other glands, the medicines must be used by the 
mouth, if it be from the colon or rectum, or from haemorrhoids, medi- 
cation must be by way of the anus. 

Haemorrhage of the first class is best combated by the taking of 
small amounts of ice by the mouth, and by the use of MonseFs salt 

1 Hasmatemesis also ensues as a result of swallowing blood which has escaped in the 
mouth or naso-pharynx, and is sometimes induced by malingerers in order to further 
their ends. These forms should, of course, be separated from those dependent upon 
some lesion in the stomach itself. 



460 DISEASES. 

(Ferri subsulphatis). Three grains should be given every half hour 
or oftener, the pill being made hard enough to reach the intestine 
without being altered or decomposed in the stomach. 

The use of ergot is wise and should always be resorted to, and 
tannic acid may be given in large amount in solution or pill with 
advantage if the MonsePs salt is not obtainable. The other remedies 
which are of service are sulphuric acid in the dose of 5 to 10 drops 
in water in acute or passive bleeding, or turpentine given in capsule, 
or better still in emulsion with acacia in the dose of 10 drops every 
half hour, particularly where the haemorrhage is not active. Acetate 
of lead and camphor in the following pill may be of service in some 
cases : 

R. — Plumbi acetat. . . . . . . gr. v. 

Camphorae . . . . . . . . gr. x. 

M. Ft. in pil. No. v. — S. One pill every hour. 

Where the haemorrhage is dependent upon ulceration of the colon 
or rectum, injections are to be resorted to. These are both styptic 
and curative, the styptic injections being particularly useful when 
the bleeding is to be stopped at once, the others where it is sought 
to remove the condition producing the trouble. 

To the first class belong alum, sulphate of copper, MonsePs solu- 
tion, sulphate of iron, tannic acid, and cold water. In the second 
we find nitrate of silver, the sulphates of copper and of iron, »nd 
the chlorate of potassium. 

The alum solution used should be fairly strong, 10 grains to the 
ounce ; the copper, 5 grains to the ounce ; the MonsePs salt, 10 grains 
to the ounce ; or, 1 drachm of the MonsePs solution to each 2 ounces. 
The tannic acid should be used in the strength of 20 grains to the 
ounce of water and glycerin. When chlorate of potassium is used 
it should be employed in saturated solution in small injections (25 
grains to the ounce), or weaker if the injection be a large one (10 
grains to the ounce). 

These injections should be carefully given, and the success or fail- 
ure attending the treatment of these states depends as much on the 
technique of the operation as upon the injection of the medicinal 
substance. It should never be forgotten that an injection designed 
for medication should be as small as circumstances will permit. 
Thus, in inflammation of the rectum the amount of the injected 
liquid should not be above 4 ounces at the utmost, and preferably 
2 ounces unless the ulcer is high up. Au enema is given in bulk 
so as to cause distention and excite the bowel to movement, whereas, 
from a medicinal injection no movement is desired. Again, the appa- 
ratus for sending in the fluid ought not to be a "family 7 ' or ordinary 
syringe but a fountain syringe, the pressure being hydrostatic. This 
may be dispensed with to be sure if the injection be small and only 
intended for the lower part of the rectum, but is indispensable if the 



HEMORRHAGE. 461 

injection be intended to reach the upper part of the colon. The en- 
trance of the liquid should always be gradual and easy. If resistance 
is met with the pressure must be overcome, not by force, but by 
waiting a moment until it passes off. When the entire colon is to be 
flooded at least a gallon of warm liquid may be needed. In these 
cases those drugs which are capable of absorption and the production 
of poisonous symptoms, are not to be used except in small amounts. 

Sometimes, in dysentery, the injection of a pint to a quart of ice- 
cold water has a most favorable effect upon bloody purging. When- 
ever a medicated injection is to be used, the entire tract which is to 
be invaded should be washed out with pure water or with a saline or 
soapy liquid, in order to clear out mucus and fseces which prevent 
the drugs from acting on the bowel wall. 

Hcematuria is a condition in which blood appears in the urine, 
and it may be divided into two classes, those in which the 
blood comes from the kidney or bladder, and those in which it 
comes from the urethra. In the first class the blood is always well 
mixed with the urine, which is changed in color from its decomposi- 
tion, and appears either through the entire act of urination or just at 
the end of the act. In those instances in which the blood is in the 
first part of the stream it arises in the urethra, is nearly pure, and 
is not well mixed with the urine. 

If the blood is due to the presence of an acute nephritis, the 
kidneys need treatment, and for directions as to this point the 
article on Acute Bright' s Disease should be read ; while, if it is 
due to the presence of a lesion in the bladder, the directions govern- 
ing the use of turpentine, erigeron, or ergot, as given for menor- 
rhagia and metrorrhagia, should be followed; or, if any morbid 
growth be present, it should be removed. Sometimes 10 to 20 grains 
of camphor in divided doses are of service, given in pill form, while 
in others cannabis indica is of value. 

Gallic acid, in 20 grain doses, may be used, and is very valuable. 
If the haemorrhage is alarming, injections of astringent washes, such 
as two to three grains of alum to the ounce of water, should be sent 
into the bladder. It must be remembered, however, that this simply 
fills the bladder with clots which are not readily passed and are 
liable to become septic. 

A very useful prescription is : 

R. — Acid, gallic gj. 

Acid, sulphuric, dil. . . . . •. . igij. 

Aquas . . . . . . . . q. s. f 25 nj. 

M. — S. Teaspoonful in water every four hours. 

If the hematuria be malarial, quinine should, of course, be em- 
ployed. 

Post-partum hcemorrhage is to be controlled by the use of friction 
and kneading or grasping the dilated uterus through the relaxed 
abdominal wall, by the use of drachm doses of the fluid extract of 



462 DISEASES. 

ergot or a wineglassful of the wine of ergot, and by the irritation of 
the uterine wall by passing the hand up through the vagina into the 
uterine cavity. Sometimes ice may be passed up the vagina and into 
the uterine cavity with success in stopping the bleeding, and even 
vinegar and lemon juice may be tried if the case is a desperate one. 
In other cases injections of water as hot as can be borne may be 
resorted to. 



HEMORRHOIDS. 

These painful, annoying, and often serious, dilatations of the 
hsemorrhoidal veins about the rectal opening may be internal or 
external, bleeding or " blind. " In nearly every instance where they 
are prominent and troublesome the only cure rests in operative 
measures for their relief; but, nevertheless, much can be done for 
the alleviation of the pain and discomfort produced by them. Con- 
stipation is nearly always an annoying symptom, and should be 
relieved by the proper diet (see Constipation), and by the use of 
sulphur or aloes. The latter drug has been highly praised and 
severely condemned by equally eminent observers. The author, 
however, is not favorable to its use. (For formulae, see article on 
Constipation.) 

In some cases the injection of a pint of cold water in the morning 
will relieve congestion and permit an easy evacuation of the bowels, 
or 10 to 20 grains of rhubarb root may be chewed each night before 
retiring. A very serviceable local application is hamamelis, either 
in the form of a lotion or injection (1 drachm to the ounce), and an 
ointment of gallic acid and opium is of value, made as follows : 

&. — Acid, gallic . . gr. x. 

Ex. opii . . gr. iv. 

Ext. belladon. ....... gr. iv. 

Ung. simplicis g iv. 

M. — S. Apply night and morning. 

For the surgical treatment of piles reference must be made to 
surgical works. 

HEPATITIS. 

(Acute and Chronic Hepatitis, and Hepatic Abscess.) 

Inflammation of the liver may be produced by many causes, such 
as injuries, cold, exposure to high heat, as in the tropics, syphilis, 
and the presence of any infectious disease or of parasites. It may 
also arise from alcoholism. The acute form is rarely produced by 
syphilis directly, unless by the presence of some other form of the 



HEPATITIS. 463 

disease, and the same may be said of the hepatitis of hot climates, 
which is generally subacute or chronic. The pain, swelling, and 
general symptoms of the acute form of inflammation of the liver 
are described thoroughly in the text-books. The measures commonly 
adopted for the relief of the symptoms and the disease itself are of 
two kinds. The first, medicinal ; the second, dietetic. 

The patient, if the attack be acute or severe, will commonly be 
found in bed from the pain and fever, but, if not, he must be placed in 
bed and kept in a recumbent posture. Over the surface of the right 
hypochondrium should be placed two cantharidal blisters of the 
diameter of from 1 to 3 inches, or, if this is not possible, a large 
mustard plaster is to be used. Sometimes hot cloths applied over 
this area not only give relief, but also aid in the formation of the 
blister. At the same time, if the bowels are greatly confined, a 
saline purgative may be given, and be preceded by 1 grain of 
calomel in fractional doses. In regard to internal medication the 
physician should recollect that hepatitis is, like every inflammation, 
a local hyperemia or vascular engorgement, and, in consequence, 
that aconite, in full doses, is useful. Veratrum viride may be used, 
but as it may produce vomiting and disturb the liver it should 
rarely be employed. The kidneys may be kept active by spirit of 
nitrous ether and citrate of potassium, or by any one of the diuretic 
waters, such as Vichy. If the inflammation is not aborted by 
this treatment it will go on to hepatic abscess. 1 If hepatic abscess 
develops the best thing to be done is to aspirate and draw off the pus. 
Very frequently the inflamed organ will form so strong an attach- 
ment with the peritoneal coat of the abdominal cavity that a bistoury 
may be used to free the pus if an aspirator is not at hand. After 
pus is once formed any constitutional evidence of its presence as by 
night-sweats, hectic or rigors, is a sign for immediate interference by 
the physician with the purulent collection. If dysentery exists it 
must be cured as rapidly as possible. 

The diet during the early stages of acute hepatitis and during its 
later stages is almost identical, and may be resorted to in the sub- 
acute and even in the chronic forms of the disease. It should con- 
sist of koumyss to a great extent, or matzoon may be employed, and 
" strong foods/' such as meats of all kinds, particularly beef, pork, 
and mutton, are to be avoided sedulously. All spices in the food 
must be forbidden, and alcohol utterly tabooed. If koumyss cannot 
be had the patient may be fed on peptonized milk or pancreatized 
oysters. (See page 329.) After abscess develops the same recom- 
mendations are to be followed, and the diet is to be as supportive 
as possible, small doses of quinine being used. 

In the treatment of the subacute or chronic hepatitis of hot cli- 

1 Just here it may be recalled that many cases of hepatic abscess are now known to 
be clue to dysentery, and that the diseased state of the lower bowel in this condition 
may infect the liver. 



464 DISEASES. 

mates no remedy compares to freshly prepared strong nitro- 
muriatic acid used both externally and internally. The acid should 
be dark-red, not orange colored, and be mixed with water only when 
about to be taken, in the dose of 3 to 4 drops three times a day. 
This remedy is contra-indicated in acute hepatitis, because it acts by 
stimulating the organ up to its normal position, and would only in- 
crease the acute form of the disease if administered at this time. 
Externally, it is to be used by mixing it with water and applying it 
by means of a flannel wrung out in the solution, or by placing it on 
spongiopiline in the following proportion : Take from 1 to 8 fluid- 
drachms to the pint of warm water and apply over the liver, and if 
3 fluidrachms irritates the skin too greatly, use the smaller quantity. 
This causes a tingling of the skin and a localized sweat. 

The hepatitis due to syphilis generally shows itself as a cirrhosis, 
and is to be treated by anti-syphilitic measures. (See Syphilis.) 

If ascites from cirrhosis develops the liquid is to be withdrawn, 
and frequent withdrawals, as often as the liquid returns, have been 
known to result in final cure or arrest of the disease. In all forms 
of chronic hepatitis iodide of potassium is a useful remedy in the dose 
of from 5 to 10 grains three times a day, or larger amounts may 
be used if the case be specific. 



HICCOUGH. 

This is an affection depending upon irritability of the nerves 
supplying the diaphragm arising from many causes, such as gastric 
irritation, nervousness, uraemia, and as a complication of several 
exhausting diseases, such, for example, as typhoid fever. 

The mechanism of its production rests upon the sudden contrac- 
tion or descent of the diaphragm, whereby a vacuum is formed in the 
chest into which the outside air attempts to rush, but is prevented 
from doing so by a sudden closure of the glottis, the peculiar sound 
of the hiccough being thus developed. Generally the symptom 
stops of itself, but it may become excessive. 

The remedies to be employed are used according to the cause of 
the condition. If there be gastric or intestinal irritability then the 
irritating matter must be removed by emetics or purges, and nervous 
and local sedatives used. A few drops of spirit of chloroform do 
good in many cases, and a little tincture of capsicum may be em- 
ployed in other instances, say 2 to 3 drops well diluted, even for 
adults. Spirit of camphor, or the tincture of valerian, in the dose of 
1 drachm may be serviceable, and Hoffmann's anodyne is peculiarly 
appropriate. In the hiccough of typhoid fever nothing compares to 
musk, 10 grains by the rectum, and, if this cannot be used, then oil 
of amber may be given in the dose of 5 to 10 drops in capsule or 
emulsion. 



INCONTINENCE OF UKINE. 465 

Where external remedies are resorted to, ether thrown in a fine 
spray on the epigastrium may stop an attack. 

In cases where the affection comes on after meals, and is due to 
indigestion, a course of tonic treatment will often give relief. Thus 
mix vomica in pill or tincture, and accompanied by some dilute 
mineral acid, such as hydrochloric or nitric, may be employed. 

If the symptom be due to uraemia, a hypodermic injection of 
muriate of pilocarpine will be found of service unless it is contra- 
indicated by advanced depression and weakness. 



INCONTINENCE OF URINE. 

Incontinence of urine may be classified either according to its 
forms or the methods of its treatment. 

Four varieties may be recognized as occurring separately, although 
all of them may occur in one case. These are those cases where the 
bladder fails to hold the urine day or night, those in which the 
incontinence is only nocturnal, and those in which it occurs only 
upon some nervous start, or in which the sphincter becomes relaxed 
from general atony. The first of these occur in children, the latter 
instances in adult females. A fourth form of incontinence depends 
upon paralysis arising from centric nervous disorder or from paraly- 
sis due to retention and consequent paralytic distention. 

Taking up the consideration of the first forms, namely, those 
occurring in children, in which the trouble is generally nocturnal, 
the complete history of the case and the present condition must be 
discovered. Many of the most obstinate cases will yield when the 
urine is made clear and mild by the use of alkalies, and others will 
recover upon the removal of worms from the vagina, which have 
crawled there from the rectum, or upon circumcision of a redundant 
prepuce, particularly if this be tight and smegma be found back of 
it in large quantity. The cause of the incontinence in both these 
conditions is reflex irritation, by the urine on the bladder walls or 
by irritation at the end of the penis, and the reason that alkalies do 
good is that they render the urine, which is concentrated and irri- 
tating, dilute, alkaline, and mild. The use of belladonna in these 
cases is rarely if ever curative, and is at most only palliative, the 
condition returning just as soon as the effects of the drug permit the 
irritation to be felt by the nerves of the bladder. f-il^ 

Where the urine is concentrated and dark in color, the following 
prescription is always useful : 

R. — Potas. citrat. Jss. 

Spt. aether, nitros. . . . . . . f^vj. 

Aq q. s. fgvj. 

M. — S. Dessertspoonful every four hours in equal parts of water. 

30 



466 DISEASES. 

As the urine becomes clear, after several days, a few drops of 
tincture of belladonna may be added to the mixture ; but if a little is 
not sufficient then it must not be increased, as belladonna will not 
cure the condition and will make the urine concentrated, a condition 
directly opposed to that which is wanted. 

Sometimes these cases are dependent not so much upon vesical 
irritability as upon weakness of the spinal centres governing the 
bladder. If this be the case the remedies used should be directed to 
the improvement of these parts, and the following pill should be 
recommended, or the succeeding solution : 

R. — Acid, arseniosi g r - 3- 

Ext. nuc. vom. ....... gr. ij. 

M. — Ft. in pil. No. xx. S. One t. d. after meals for a child of eight or ten 
years. 

Or, 

Be . — Liq. potas. arsenit. ...... gtt. xxiv. 

Tinct. nuc. vom. . . . . . . . gtt. xvi. 

M • q- a- f 3 "J- 

M. — S. Teaspoonful t. d. after meals for a child of eight or ten years. 

This is so bitter as to be exceedingly disagreeable and Fowler's 
solution may often be used alone in the dose of \ to 1 drop. 

It must be remembered that this last treatment is only to be em- 
ployed in chronic cases devoid of all irritation and dependent upon 
atony. It will not do good if the urine is not previously made clear. 

Nothing can be more unfortunate in the treatment of these cases 
than punishment by severe scolding and whippings, as they never do 
good, and the fault being beyond the child's control the unjust pun- 
ishment makes him sullen, or through nervousness his trouble becomes 
worse. In some cases it may be necessary to let the child use diuretic 
waters for years to cure the habit, and the patient should always be 
taken up from bed when the parents retire for the night and made to 
evacuate the bladder. 

In the incontinence of adult females or males, on laughing or 
sudden movement, nothing compares to drop closes of cantharides 
three times a day, the urine being kept flowing freely from the kid- 
neys by means of alkaline diuretics. 

The treatment of the fourth form of incontinence of urine comes 
into the province of surgery. The bladder must be relieved by the 
catheter if the trouble be from retention. If from paralysis nothing 
can be done, except to carry out those general measures valuable in 
such cases, and to maintain the urine in as normal a state as possible 
by frequent catheterization w T ith an aseptic catheter and by wash- 
ing out the bladder every few days or hours, as the case may be, 
with some weak antiseptic fluid such as 1 to 10,000 solution of 
bichloride of mercury, or 1 to 100 of carbolic acid. 



INDIGESTION, GASTRIC AND INTESTINAL. 467 



INDIGESTION, GASTRIC AND INTESTINAL. 

Under the heading " Biliousness " the writer has already described 
many of the conditions arising out of indigestion, and this being the 
case the consideration of that state known as dyspepsia or indigestion 
will only receive attention at this point in so far as its relief is con- 
cerned, without the relief of the symptoms produced. 

Lack of gastric digestion depends for its existence upon a very 
great number of causes and is always a symptom, not a disease. It 
occurs during the course of prolonged or short fevers, from atony of 
the gastric walls and glands, from lack of secretion of the proper 
character, from hypersecretion of mucus by the mucous glands, and 
by fermentative changes in the food, or as the result of any one or all 
of these conditions, and lastly because the food is unsuitable to the 
case or is of a kind difficult of assimilation, or is readily split up into 
effete products by the juices of the organ. Sometimes it is due to 
organic changes in the viscus, as carcinoma or ulcer, and sometimes to 
acute or chronic gastritis. In each of these states the treatment is of 
course different. 

The indigestion attendant upon the course of fevers can nearly 
always be avoided by a proper diet and the use of predigested food, 
such as pancreatized beef-tea, milk, or broths. 

The necessity of this artificial digestion is the more readily recog- 
nized, when we recall the investigations of Hoppe-Seyler upon the 
quality of the gastric juice of a patient suffering from typhus fever, 
for he found that no hydrochloric acid was present. Uffelmann 
has also found in a similar study that the peptone-forming secretion 
of the stomach ceases entirely during fever. 

Generally, if the disease is adynamic, alcohol should be taken with 
the food, so that the stimulating effect of the drug will cause gastric 
and intestinal activity. A very important point to be remembered, 
is that the exercise of the function known as digestion requires force, 
and that digestion fails in cases of fever because the system lacks the 
force required to carry out the act. 1 As alcohol adds force to the 
system it aids digestion, and should be varied in the amount given 
according to the state of the organism, and particularly of the stomach 
itself. During the stage of convalescence from fevers or other acute 
diseases the digestive functions are to be kept up to the mark by 
bitter tonics and a gradual decrease in the amount of alcohol insisted 
upon, lest the alcoholic habit be set up. The tonics may be given 
in the formulae found on the next page if desired. 

In the gastric atony dependent upon overwork or fatigue of mind, 

1 Very few of us realize the amount of force used up in the body in daily life. It is 
almost impossible to estimate the amount used in digestion, but we know that gland- 
ular secretion is very powerful, so powerful in the salivary glands as to be twice that of 
the blood-pressure in the carotid artery, if necessity requires it. (Ludwig.) 



468 DISEASES. 

as well as body, tonics are to take the place of alcohol, which is pecu- 
liarly apt to give rise to the alcohol habit in such cases. These tonics 
are always bitter and depend for their activity upon this property. 
The most powerful of them are nux vomica, or its alkaloid strych- 
nine, and quinine, both of which drugs, however, exercise a more 
powerful effect on other parts of the body than on the stomach. The 
other bitters are gentian, cardamoms, quassia, chiretta, and col umbo, 
all of which may be used with great success in combination with one 
another or alone. 

The following formulae are useful, but before naming them it is 
proper to call attention to the fact that all tonics are contra-indicated 
if any irritation of the stomach is present, because they are stimu- 
lants and irritate the gastric walls all the more if these walls are 
already inflamed. 

R. — Ext. nuc. vom. . . . . . . gr. iv. 

Ext. quassise gr. xx. 

Quin. sulph gr. xl. * . 

M. — Ft. in pil. No. xx. S. One pill t. d., after meals. 

Or, 

]£. — Tr. nuc. vorn. ...."... fgj. 

Tr. cinchon. comp. . . . . . q. s. f^iv. 

M. — S. Teaspoonful after each meal. 
Or, 

B:. — Ext. chiratse ...••.. gr. xl. 

Ext. gentian gr. xl. 

Oleoresin. capsici Ttl v - 

M. — Ft. in pil. No. xx. S. One after each meal. 

Where the failure of digestion rests upon a deficient secretion and 
it is desired to increase the rapidity of the act by purely artificial 
means, we may rely upon pepsin and hydrochloric acid, but if this 
is done it should be resorted to with a clear idea of why they are 
prescribed. 

Very commonly in the treatment of gastric dyspepsia proper, pepsin 
is given in such absurdly small doses as to be almost useless, and yet 
the prescription as it is taken is intended to aid the true gastric juice 
which is not thought strong enough to be capable of performing its 
functions aright. This is not by any means the result attained in the 
majority of cases, for the following reasons — indeed the direct diges- 
tive action of the dose administered probably brings about the 
smallest part of the good achieved : 

It is a mistaken idea to believe that pepsin and hydrochloric acid 
are simultaneously secreted and utterly independent bodies, or, in 
other words, that the pepsin may be formed even if the glands fail 
to form the acid. We know, from the experiments of Heidenhain, 
and of Langley, as well as many others, that pepsin, as such, is not 



INDIGESTION, GASTRIC AND INTESTINAL. 469 

secreted by the glands ready formed, but that these tubules secrete a 
so-called " mother substance" called pepsinogen, which is absolutely 
impotent until it is changed into pepsin by the presence of hydro- 
chloric acid or sodium chloride. Consequently, we learn that the 
two digestive elements are very closely associated, and that no acid 
means no pepsin. 

In normal life this acid is derived by the splitting up of the chlor- 
ides in the blood supplying the glands by the lactic acid which is 
present almost constantly in the stomach, owing to the decomposition 
of carbo-hydrates. This assertion, made by Maly, is also confirmed 
to some extent by Julius Thomseu, who has shown that very weak 
acids may displace stronger ones from their bases, and even appro- 
priate the greater part of the base. This is doubtless the reason why 
common salt is so useful a condiment, since it is broken up in the 
stomach, thus setting free hydrochloric acid, besides keeping up the 
alkalinity of the juices of the body which is so necessary to health 
and the future secretion of gastric juice. It also explains, in a very 
ingenious manner, the well-known fact that salt added to a glass 
of milk increases its digestibility to a great degree. Further than 
this the usefulness of the salt in small amount taken before meals 
does not depend entirely, as has been thought, upon an endeavor on 
the part of the stomach to neutralize the alkali present in a normally 
acid medium, whereby an excess of gastric juice is secreted, but upon 
the reasons given above. We find, therefore, that in cases where 
there is reason to believe that gastric digestion is imperfect, common 
salt should be used in increased amount in the food so that the quan- 
tity of hydrochloric acid may be increased. If, however, there is 
reason to believe that lactic acid is present in too small a quantity to 
split up this salt, then hydrochloric acid must itself be used, and, 
where it is employed, given freely in order not only to act thoroughly 
as far as its own functions are concerned, but also to perform an 
equally important function, namely, the conversion of pepsinogen 
into the active body pepsin. In other words, deficiency of pepsin 
in the juice is to be corrected, not by a prescription containing much 
pepsin and a little acid, but rather the reverse, for the pepsin in the 
prescription is after all an extraneous product, while the pepsin 
brought into being by the acid is a normal secretion. Of course the 
quantity of pepsin must depend on a normal formation of pepsino- 
gen, but it should not be forgotten, on the other hand, that as pepsin 
acts by catalysis, and is a most powerful ferment, only very small 
quantities of it are absolutely necessary, while large amounts of 
hydrochloric acid, comparatively speaking, are essential. 

Bourget has enunciated some thoughts which are so completely in 
accord with the views here expressed as to be worthy of quotation. 
He believes, as does the writer, that the hydrochloric acid is generally 
the secretion which is lacking in amount and recommends its free 
employment as the most important part of the treatment of gastric 



470 DISEASES. 

indigestion. He does not seem to do this, because he believes it to 
increase the pepsin, but only because he thinks the acid secretion is 
more apt to be deranged than is that of the ferment. According to 
practical experience, and the equally reliable information gained by 
experimental research, it is to be concluded, therefore, that pepsin is 
to occupy the least prominent position in a prescription for gastric 
disturbance, and that the acid is to be freely used. 

Where indigestion results from the presence of gastric catarrh the 
remedies applicable to such a state must be resorted to. (See Gastric 
Catarrh.) 

In many cases in which distress comes on some time after eating, 
the trouble is due to the development of large amounts of lactic and 
butyric acid in the stomach, and but one remedy can be given unless 
the patient will vomit himself by tickling his pharynx or swallowing 
an emetic. The remedy of a less violent character spoken of is 
ammonia. Sometimes patients go from physician to physician with- 
out relief, only to be cured in the end by some one giving them 10 to 
20 drops of the aromatic spirit of ammonia for each attack. 

In other cases the cure of this condition rests upon the removal of 
the state of atony or dilatation of the gastric walls. (See Gastric 
Dilatation.) 

Intestinal indigestion depends upon almost the same causes as does 
gastric dyspepsia, and is to be treated in much the same manner, 
chiefly by a careful study and regulation of the patient's diet, and by 
the use of a number of remedies calculated to supplant to some ex- 
tent the normal juices by artificial ferments, given with the meals, or 
the food prepared in a predigested form before it is taken. 

Pancreatin should be given in good dose (5 to 10 grains), with bi- 
carbonate of sodium, and alkaline mineral waters used. (See Bilious- 
ness.) 

Sometimes where intestinal indigestion is present great flatulence 
often comes on and is an annoying symptom. Very commonly in these 
cases it will be found that the patients think they have heart disease, 
because of the pain they suffer under the prsecordium. This pain is 
due to the accumulation of flatus in the small intestine, or more com- 
monly to its pressing upward at the augle where the transverse colon 
turns to go down to the descending colon and sigmoid flexure. 
Under these circumstances the following prescription will be found 
of service. 

B.. — Acid, nitric, dil fzj. 

Ti net. cardamom, comp. ..... f^vj. 

M. — Dessertspoonful in water four times a day. 

In old persons flatulence is frequently found in the large bowel, and 
is often associated with atony of the muscular coats of the gut. 

Under these circumstances the following prescriptions will be 
found of service : 



INSOMNIA. 471 

R. — Asafoetidae gr. xl. 

Ext. nuc. vom. . . . . . . . gr. iv. 

Ext. physostig. . . . . . . . gr. iii. 

Oleoresin. capsici ....... TTLx. 

M. — Ft. in pil. No. xx. S. One pill t. d., two hours after meals. 

Or, 

R. — Tine, belladonnse f ^ i j . 

Tine, physostig. . . . . . . . f^j. 

Spt. camphor q. s. fjfiij- 

M. — S. Teaspoonful two hours after meals, or whenever needed. 

Where intestinal indigestion results in lientery the treatment be- 
comes entirely changed, except in regard to the use of a predigested 
milk diet, and efforts must be made to increase the secretion of the 
glands of the intestinal wall. Often minute doses of mercury or 
podophyllin may do this, as ^ to -fo grain of the first or second, 
respectively. More commonly, however, the mixture of nitric acid, 
given above, will be in order, or, perhaps, the followiug, if the liver 
be found to be torpid : 

R. — Acid, nitro-hydrochlor. (not dil.) . . . f^j. 

Infus. gent. comp. . . . . . q. s. f^vj. 

M. — S. Dessertspoonful every four hours or after meals in water. 



INSOMNIA. 

Insomnia is a condition characteristic of almost every disease in 
some of its stages, and arises from such a host of causes that the 
physician may not be able to discover any one of them for days after 
the patient is first seen. As a general rule, the patient consulting a 
physician with this symptom expects a prescription to be given at 
once and the cause found out afterward, or, in other instances, wil- 
fully defeats all the efforts of the practitioner for one reason or another, 
but desires relief although he may not choose to aid in its attainment. 
Under these circumstances the physician may safely employ certain 
drugs according to the information concerning the patient's state that 
he may have. 

One of the most common remedies is chloral given in the follow- 
ing manner : 

R. -Chloral giv. 

Syr. simplic. . . . ... . fgiv. 

Aq. cinnamomi . . . . . . q. s. fjiij. 

M. — S. Dessertspoonful at night, 

Or, 

R. — Butyl chloral-hydrat. . . . . . . £j. 

M. — Et. in pil. No. xii. S. One, two, or three pills at night as needed. 

Where, for any reason, as the presence of a weak heart, chloral is 
contra-indicated, resort may be had to the bromides, and if so, and 



472 DISEASES. 

the patient is a female, the drug should always be accompanied by a 
small dose of arsenic, generally in the form of Fowler's solution, 1 
to 3 drops three times a day. The following prescription is useful : 

R. — Potas. bromid. . . . . . . . gij. 

Liq. potas. arsenit. . . . . . . f^ss. 

Aq. cinnamomi q. s. i^vj. 

M. — S. One to two dessertpoonsfuls at night. 

In many cases larger amounts of the bromide will be needed. 

Where the sleeplessness is due to pain, chloral is of little value and 
bromides are worth but little more. Under these circumstances, by 
using what is known as the "crossed action of drugs " we can often 
obtain a very good effect. Thus morphine and chloral both act on 
the brain to produce sleep or, in other words, their action is here 
crossed, but one relieves pain and the other does not, one kills by 
failure of the heart in overdose, the other by respiratory failure. 
As a consequence large doses of neither one can be given alone. The 
following is therefore a useful combination either where one drug 
fails, or dangerously large doses of either one have to be used to 
obtain the desired result : 

R. — Morphinse sulph. ...... gr. iv. 

Chloral . sp'j. 

Aq q. s. t ^iv. 

M. — S. Dessertspoonful at night. 

In cases where insomnia is due to mania, hyoscine is very useful, 
given in the dose of t ^-q- to -^ grain by the mouth or, y^- to T ^- by 
the hypodermic needle. Owing to its tastlessness the powder may 
be put on the tongue, but it is best to order a little sugar of milk or 
white sugar (1 grain) to every small dose of hyoscine, in order to 
give it bulk. 

Where insomnia follows mental effort, avoidance of all cerebral 
activity should be insisted upon during the evening, and if the feet 
are cold sleep should be induced by the use of a hot-water bag at the 
feet and cold to the head. 

During the last few years a very large number of remedies have 
been introduced as hypnotics, such as somnal, paraldehyde, chloral- 
amide, sulphonal, amylene hydrate, and others. None of them com- 
pare in therapeutic activity with the older remedies although sul- 
phonal and chloralamide seem to be the best of the lot. The dose of the 
sulphonal is 10 to 20 grains in powder, but as it is large in bulk and 
hard to swallow it should be used in a prescription made up as fol- 
lows : 

R. — Sulphonal gr. xxx. 

Syrup. . . fgij. 

Mucilag acacia? ....... fgij. 

Aq. destillat. q. s. f^j. 

M. — S. Half to all of this at one dose, as may be needed. 



INTERMITTENT FEVER. 473 

Chloralamide is given in the dose of 15 to 60 grains dissolved in 
wine or given in capsule. Paraldehyde is given in the dose of 20 to 
60 minims. As it is disagreeable in odor and taste, it must be given 
in capsule, and is very apt to disorder the stomach. 

The dose of amylene hydrate is the same as that of paraldehyde. 
It is a liquid and has no effect in insomnia from pain. 

Somnal is used in the dose of 10 to 40 minims with licorice and 
water, and possesses considerable power. 

In the treatment of insomnia it should be remembered that drugs 
should be used which if possible, will quiet the part of the brain 
which is most active. Thus if the patient tosses much, we use bro- 
mides and chloral as motor depressants. If sensation is active 
bromides and the hot-pack as sensory quietants. 



INTERMITTENT FEVER. 

In all forms of intermittent fever, whether the attacks are diurnal, 
quotidian, tertian, or quartan, the best remedy for their prevention is 
quinine, which should, under these circumstances, be given about 
two or three hours before the attack is expected, so as to be absorbed 
and physiologically active when the paroxysm is due. This is often 
overlooked, and the dose ordered at the time of the expected attack, 
with a failure as a result. Not only should this be done, so that 
sufficient time may elapse for absorption, but the fact should be 
remembered that the chill often begins an hour earlier each day, and 
will be in full sway before the quinine can stop it, if the drug be not 
administered at the proper time. Experience has proved that 
quinine never acts as favorably if constipation is present as when the 
bowels are lax, and hepatic activity seems particularly necessary for 
its full effect. To obtain the full influence of the drug it should be 
preceded, by some four or five hours, by ^ to J grain of calomel 
every fifteen minutes until a grain is taken, or by a dose of podophyllin 
amounting to y 1 ^- to J- grain. If podophyllin is used, a longer time 
should be allowed, because of its slow action. 

The dose of quinine varies with the exigencies of the case, which 
in turn generally depend upon the region in which the patient lives 
or has lived. Ten to fifteen grains in one dose are generally suffi- 
cient in the eastern and northern States, but as much as twenty to 
forty-five or even sixty grains may be required in the southern parts 
of the United States and elsewhere. When these very large doses 
are employed, the drug should be given partly hypodermically and 
partly by the rectum in suppository, or solution, as well as by the 
stomach. (For the best salts for hypodermic use, see article ou Cin- 
chona, page 128.) If the stomach is irritable, these means of 
entrance into the body are absolutely necessary. 



474 DISEASES. 

In cases where the attacks are several days apart, small doses of 
3 to 6 grains are to be taken daily between the paroxysms, or, what 
is better, arsenic may be given in moderate sized dose for its anti- 
periodic influence during the intermission. In this manner the 
quinine acts with full force when most needed. 

Having considered the prophylaxis of a chill let us turn to the 
treatment of the attack itself. It must be remembered that the 
chief harm of the malarial poison is exerted at this time by the 
dangers of internal congestions and engorgement of the abdominal 
and thoracic organs. The physician should, therefore, try to prevent, 
as far as possible, too great a rigor and, if stasis results from the 
chill, overcome it, not by depletants, unless the case is very sthenic, 
but by stimulants, such as digitalis, which will drive out the blood 
from the congested area. 

If a full meal has just been eaten the stomach should be emptied 
by an emetic dose of ipecac, 2 drachms of the powdered drug to an 
adult, or by 20 grains of sulphate of zinc. There is no use of giving 
quinine at this time, as absorption from the stomach and subcuta- 
neous tissues is almost stopped. 

Alcoholic stimulants are not to be employed. If the chill is 
severe enough to endanger the patient's life measures must be used 
to control it. Chloroform may be inhaled and immediately pre- 
ceded by laudanum by the bowel or mouth. If given by the mouth 
a little ether or chloroform may be added to the dose. The opium 
may be used hypodermically in the form of morphine, in the dose of 
jr of a grain combined with -^ of a grain of atropine. 

In the fevered stage little can be done, except to add to the patient's 
comfort by cool drinks and cool sponging, or if the fever becomes 
excessive by the use of antipyrine or the ice-pack. The latter has 
seldom to be used, as the fever is generally too fugitive to need such 
measures. 

The sweating stage needs no measures for itself, unless exhaustion 
is caused by it, when stimulants may be cautiously used as needed, 
and large draughts of water at ordinary temperatures be swallowed. 

Many measures have been resorted to to put off a malarial attack, 
the chief of which is the use of ether or chloroform anesthetization 
at the time of the expected paroxysm, or of the nitrite of potassium or 
sodium in 10 grain dose for the same purpose. Where the " chill 
habit" exists and depends largely upon nervousness it has been 
broken by misplacing the hands of the clock, and so getting the 
patient past the time for his attacks without his knowledge. 



IRITIS. 

Iritis, or iuflamation of the iris, as usually encountered is caused 
either by syphilis, rheumatism, or gout. It may also be traumatic; 



ikitis. 475 

less frequent causes are gonorrhoea, diabetes, malaria, and tuber- 
culosis. Metastatic iritis occurs in pyaemia, relapsing fever, etc. The 
most marked symptoms are severe brow pain ; fine ciliary injection ; 
discoloration of the iris and immobility of the pupil, due to the for- 
mation of adhesions between the iris and the capsule of the lens. 
The most important local remedy is atropine, to be used every two 
hours according to circumstances. If for any reason this is not toler- 
ated, duboisine, or daturine may be substituted. Cocaine increases 
the mydriatic power of atropine. 

Pain may be relieved by leeches to the temple and the use of dry 
heat externally (cotton batting heated over a register will suffice) or 
hot fomentations — water, chamomile infusion, or laurel-water (1 to 

15). 

In traumatic iritis iced compresses are suitable in the early stages, 
but not in the later periods, and not in any other form of iritis. 
Great care must be taken not to mistake iritis for conjunctivitis on 
the one hand and glaucoma on the other; delayed use of atro- 
pine and the employment of astringents on account of the former 
error, or the instillation of atropine because of the latter, would 
constitute serious therapeutical blunders. In serous iritis, or that 
variety in which there is a hypersecretion of the aqueous humor, 
which becomes turbid, and a precipitate of dark spots occurs upon 
the membrane of Descemet, atropine must be cautiously instilled, 
owing to the tendency to increased tension. If this occurs, paracen- 
tesis of the cornea may be needed, and pilocarpine should be given 
internally, if the vitreous becomes opaque. 

In true syphilitic iritis, mercury must be pushed to the point ot 
tolerance, but it is not necessary to salivate the patient. Any form of 
mercury usually employed in secondary syphilis may be used — 
calomel, blue mass, or protiodide of mercury — but the most effica- 
cious method is by inunction ; this is preferable even to hypodermic 
medication in the opinion of many authors. After the mercurial 
impression has been made, and the pupil is well dilated, potassium 
iodide, either alone or in combination with bichloride of mercury, is 
indicated. 

In plastic iritis, appearing six to eight months after the disappear- 
ance of the secondary symptoms, this latter treatment, without the 
previous use of mercury, has been recommended. CarmichaePs 
plan, consisting in the administration of drachm doses of turpen- 
tine, in addition to which potassium iodide may be given, receives 
the endorsement of some surgeons. 

Rheumatic iritis calls for salicylic acid, oil of gaultheria, and, 
later, potassium iodide; in the chronic types of the affection Zolli- 
coffer's mixture is an excellent remedy. Potassium iodide should 
be administered in gonorrhoeal iritis and relief occasionally follows a 
pilocarpine sweat. In other forms of iritis the treatment of the con- 
stitutional disorder which has occasioned the local inflammation is 



476 DISEASES. 

necessary, and if the iritis become purulent, surgical interference is 
usually required. In any variery of iritis the intense pain should 
be alleviated with morphine, or other anodyne sufficiently active to 
secure sleep. During the course of the disease saline laxatives may 
be administered, and after the subsidence and cessation of the specific 
treatment, a course of iron tonics is an excellent routine practice. 



KERATITIS. 

Keratitis is the name applied to the various types of inflammation 
of the cornea. If this inflammation is associated with a breach in 
the continuity of the corneal surface it is termed corneal ulcer, and 
four characteristic symptoms supply the indications for local treat- 
ment : 1, photophobia or dread of light; 2, blepharospasm or spas- 
modic contraction of the orbicularis muscle; 3, congestion of the 
bloodvessels ; 4, pain ; while any existing dyscrasia or constitutional 
condition upon which the local disease may depend, requires general 
medication. 



Interstitial Keratitis. 

Interstitial keratitis is that form of chronic diffuse inflammation 
of the cornea characterized by ciliary congestion, and a ground-glass 
appearance of this membrane, most common between the ages of five 
and fifteen, and in the vast majority of cases the result of inherited 
syphilis. No local measure is sufficient, anti-syphilitic treatment 
being of paramount importance. During the height of the ciliary 
congestion warm antiseptic lotions and atropine are indicated, the 
latter especially to prevent the tendency to iritis. Severe pain may 
be alleviated by the use of a leech to the temple, if the subject be of 
sufficient age to justify the employment of local bleeding. 

Various other types of keratitis are described as the result of 
constitutional disturbances, such as gout (Hutchinson), malaria 
(Kipp, Van Milligen), or any condition of the system associated 
with great exhaustion, such as irregularities in the menstrual func- 
tions, certain forms of pulmonary disorders (true herpes of the 
cornea, Horner). The local management of these cases does not 
differ from that which has been described. The co-existing con- 
stitutional disturbances must be combated with suitable remedies. 



Phlyctenular Keratitis. 

Phlyctenular keratitis appears in the form of small blister-like 
bodies, sometimes single, sometimes multiple, frequently situated 



SUPPURATING KERATITIS. 477 

directly at the corneo- scleral margin, which become yellow, break 
down, and leave an open ulcer (phlyctenular ulcer), to which runs a 
leash of injected bloodvessels. The disease is common in children ; 
often follows in the wake of the exanthemata, and is so frequently 
associated with a strumous diathesis that it was formerly called stru- 
mous ophthalmia. Congestion may be relieved by frequent irriga- 
tion with a warm boracic acid solution. Pain and irritation call for 
the use of atropine drops (grains 4 to the ounce), which should be 
continued until the ulcer is covered with regenerated epithelium, 
when the process of cicatrization may be hastened by the insertion 
daily into the conjunctival sac of a small quantity of yellow oxide of 
mercury salve, or dusting it with finely powdered calomel, provided the 
patient is not taking, at the same time, any form of iodide. During 
the whole treatment the eyes should be protected by dark glasses, 
and the subject permitted to go out into the open air. All local 
treatment will prove unsatisfactory unless associated with strict 
hygiene, carefully regulated diet, and constitutional measures — tonics 
and alteratives. 

If the photophobia becomes distressing in spite of the other treat- 
ment, it has been suggested that this may be relieved by the use of 
cocaine, a practice that by no means commends itself in corneal 
ulceration in spite of the temporary relief from the local anaesthesia. 
Relief of this symptom in many instances follows the use of a douche 
of cold water on the closed eyelids. 



Suppurating Keratitis. 

Suppurating keratitis, or that form of inflammation characterized 
by the formation of pus in the cornea, may be either diffuse, as, for 
example, a complication of purulent ophthalmia, or circumscribed, 
forming an abscess of the cornea. If the pus gathers in the bottom 
of the anterior chamber the condition is called hypopyon, and the 
disease hypopyon keratitis. These conditions require prompt treat- 
ment, namely, frequent application of hot compresses, which may be 
advantageously composed of slightly carbolized water, atropine drops, 
or, in the opinion of many, eserine (J to 2 grains to the ounce). If 
the abscess forms, the pus should be evacuated by a formal operation, 
either by dividing the anterior surface or by performing the opera- 
tion after the manner of Saemisch. 

In addition to the types of disease which have been described we 
have the examples of sloughing or infective ulcers, which are seen 
under a variety of conditions, and often are directly traceable to an 
injury, being more common in elderly people. The tendency of all 
of these ulcers is to spread, from whence one important variety has 
received the name serpiginous. The mild measures are antiseptic 



178 DISEASES. 

lotions, either boric acid or bichloride of mercury, iodoform, hot 
compresses, and instillations of either atropine or eserine. Formerly 
atropine was almost exclusively used ; in recent years eserine has 
been much employed. It certainly has the power of limiting a 
sloughing process in the cornea. Threatened perforation may be 
averted by a pressure bandage. This is made by placing upon the 
eye a wad of antiseptic cotton, over which, in figure-of-eight turns, a 
flannel roller is applied. If, in spite of this, the process continues, the 
following measures have met with the greatest success : Touching 
the margin of the ulcer with a strong solution of nitrate of silver, 
10 to 20 grains to the ounce, care being taken that the ulcer alone 
receives the application ; scraping the floor of the ulcer with a small 
curette or spud ; and, finally, and this is the best method, the use 
of the actual cautery. In every case of sloughing ulcer the lachry- 
mal passages must be explored for obstruction. 



Sequelae of Corneal Ulceration. 

After healing of a corneal ulcer the cicatrix consists of a more or 
less dense white spot in the cornea (macula). If these scars are thick 
and white they are irremediable by local medication, and require 
surgical interference for optical purposes. If, however, they are 
diffuse, much good will follow systematic massage of the cornea, 
aided by the introduction of a small particle of yellow oxide of mer- 
cury salve. The massage is performed as follows : A piece of the 
salve, the size of a split pea, is introduced beneath the upper lid ; 
upon the closed lid a finger is placed, and regular motions made 
through it over the surface of the cornea, namely, vertical, lateral, 
and radial motions, the seance being completed by circular move- 
ments. The whole should last from one to three minutes. 



LACHRYMAL ABSCESS. 

Lachrymal abscess results from suppuration in a chronically dis- 
tended lachrymal sac, owing to the presence of obstruction in the 
nasal duct, and exists as a swelling under the skin at the inner 
canthus, pressure upon the surface causiug an escape of pus through 
the canaliculi. The treatment is practically confined to surgical 
interference — that is, division of the canaliculi and washing out the 
distended sac with antiseptic fluids, and restoring the patulency of 
the nasal duct by the use of probes as soon as the inflammatory 
symptoms have subsided, or if the skin over the seat of the abscess 
is thinned and rupture is threatened, by free puncture downward and 
outward. Much comfort will ensue from the use of hot compresses 



LARYNGITIS, ACUTE. 479 

over the inflamed area. These may be made in the ordinary way, 
or are still more efficacious if composed of a lead lotion, the ordinary 
lead-water and laudanum answering the purpose very well. 



LID ABSCESSES. 

Lid abscesses are seen more frequently in children than adults, as 
the result of injury, the sequel of acute illness (epidemic influenza, 
pulmonary catarrhs, fever, etc.), or from local infection ; under the 
latter circumstance they may assume a gangrenous type. The treat- 
ment is, that for any form of abscess — poultices, preferably in the 
form of hot compresses, early incisions, antiseptic solutions, and 
tonics. 



LARYNGITIS, ACUTE. 

Acute laryngitis is an inflammation involving the mucous mem- 
brane of the larynx, to which it is usually confined, although it 
sometimes assumes a phlegmonous form, in which the deeper struc- 
tures of the larynx are involved. It may in form be idiopathic or 
traumatic. 

The idiopathic form results from exposure to cold, extension of 
inflammation from above or below, or a local expression of a consti- 
tutional disease, as in scarlet fever, diphtheria, or syphilis, or as an 
acute exacerbation in chronic laryngitis. 

If traumatic, it may be the result of the inhalation of foreign 
bodies, as fish-bones, pins, or from operations upon the larynx. 

The symptoms of acute laryngitis are hoarseness of voice, pain in 
the throat, tickling cough, and difficult or painful deglutition. The 
cough is often annoying and out of proportion to the amount of ex- 
pectoration. It may be of brazen or barking in character, but should 
there be much swelling is more likely to be smothered. These 
symptoms may be aggravated by dyspnoea. 

The attack may be ushered in by a chill, followed by fever, head- 
ache, pain in the back and limbs. 

Acute laryngitis may be strictly local, but, as a rule, the inflam- 
mation does not limit itself to the larynx, but extends into the 
pharynx, even reaching the tonsils. 

When the epiglottis becomes inflamed the pain is exquisite and is 
felt both in swallowing and in using the voice. Extension to the 
trachea gives sub-sternal pain, while pressure on the breast-bone 
excites coughing. 

Unless aborted, an attack lasts about a week or ten days, and may 
continue three weeks or more. 



480 DISEASES. 

A laryngoscopic examination gives us the only means of making 
a perfectly accurate diagnosis. The mucous membrane varies from 
bright red to purple, the shade depending on the severity of the 
inflammation present. 

If the inflammation be diffused, all the parts are of the same color, 
the ventricular bands and arytenoids usually being first to swell. 
(The ventricular bands may overlap the cords.) 

The inflammation may be circumscribed. The writer has seen 
instances in which the vocal cords alone escaped and remained per- 
fectly white. Sometimes only one side is affected, one cord alone 
being involved. Pyriform swelling of the same arytenoid generally 
occurs and strongly suggests incipient phthisis. The trachea when 
inflamed may be seen below the glottis, appearing of a diffused red 
color, the rings being hidden by the swelling. 

With some, every attack of coryza ends in laryngitis; or, as 
popularly expressed, the cold " goes down." 

Treatment. — Prompt measures will often abort an attack. 

During an acute attack, the patient must be kept quiet, talking as 
little as possible, remembering that whispering is more injurious 
than vocalization. The diet should be bland and unirritating, but 
nutritious. 

At the outset, a hot mustard foot-bath and demulcent drinks 
should be administered, and small, repeated doses of calomel given 
and followed by a saline purge. Fever is to be combated by aconite 
combined with a diaphoretic. An opiate — as a Dover's powder — 
may be required to relieve pain and give rest. Inhalations of steam 
charged with benzoin, camphor, or cubebs, may be used. 

Locally, the best results follow the employment of alkaline or 
astringent sprays, followed by the insufflation of anodyne and astrin- 
gent powders into the larynx. 

Gargles are of very little use in laryngitis, better results being 
obtained from the use of lozenges dissolved slowly in the mouth. 
Excessive cough may be relieved by nervous sedatives, bromide of 
sodium or potassium combined with small doses of potassium cyanide. 
Opiates disorder the digestion, and should only be used when spe- 
cially indicated. 

During convalescence tonics, fresh air, and change of climate are 
indicated. Attention to the state of the skin and the use of woollen 
underwear are advisable. 



Subacute Laryngitis. 

This form of laryngitis often occurs in debilitated subjects who 
are not vigorous enough to carry out an acute inflammation, nor have 
recuperative power to throw off an attack rapidly. It may also 



SUBACUTE LARYNGITIS. 481 

follow an acute attack when, from any cause, convalescence is 
retarded. 

It presents very little constitutional disturbance, and its symptoms 
are, for the most part, the symptoms of acute laryngitis, excepting 
that they are all of a milder type. Pain, soreness, and a burning 
sensation are referred to the region of the larynx. The voice is 
husky, and efforts at conversation excite paroxysms of coughing. 
The expectoration, at first only glairy mucus, becomes yellow and 
more abundant as the disease progresses. Laryngoscopic examination 
shows that the mucous membranes are redder than normal, but not 
the livid shade seen in the acute form. Mouth-breathing, due to 
occlusion of one or both nostrils, should be looked upon, when 
present, as a predisposing cause. 

The treatment adopted in the acute form is usually sufficient to 
produce a cure. The inhalation of steam charged with an ethereal 
oil or gum resin relieves the engorged vessels and stimulates the 
mucous membrane to healthier action. 

Compound tincture of benzoin, 30 or 40 drops in a cupful of hot 
water, has done the writer good service. An extemporaneous inhaler 
is made by covering the cup with an inverted funnel. The benzoin 
will be volatilized by the heat, and the medicated steam is readily 
inhaled from the small end of the funnel. The vapor should be 
drawn in through the mouth, gently and firmly, the breath being 
held a second and then exhaled through the nose, and the inhalation 
continued until the water cools, this process being repeated at inter- 
vals during the day. 

As this hot inhalation often induces perspiration, it may be well 
to caution the patient against exposure in the open air immediately 
after using it. This form of inhaler has the advantage of being 
simple and cheap, as well as effective, and may be constructed at a 
moment's notice in any kitchen. It is popular among the patients 
at the University Throat Dispensary. 

An inhaler devised by Dr. Carl Seiler 1 meets the requirements, 
and, being made of tin, is not injured by hot water. It consists of 
a tin cup having a lid shaped like an inverted funnel, the end of the 
funnel terminating in a rubber mouth-piece. A tin tube runs 
through the lid and reaches below the liquid in the cup. Suction 
upon the mouth-piece causes the air to be drawn down through the 
tube and bubble up through the liquid. By this means the vapor is 
more strongly charged with the preparation used. 

In addition to benzoin, we may use camphor, fluid extract of 
cubebs, or tar as inhalations which are stimulating or sedative to the 
mucous membranes in different degrees. Astringent sprays of 
sulphate of zinc, ferric alum, tannic acid, or a weak solution of 
bichloride of mercury in the hands of a physician are useful. 

1 Diseases of the Throat, C. Seiler, p. 150. 
31 



482 DISEASES. 

Even better results are obtained by the insufflation of astringent 
powders into the larynx, having first removed all adherent secretions 
by an alkaline or antiseptic spray. 

This method is more accurate than that of astringent sprays, but 
the insufflation of powders into the larynx with any degree of con- 
fidence presupposes considerable proficiency in the use of the laryng- 
oscope, a description of the methods of which would carry us beyond 
the limits of a work of this nature. 

Among remedies suitable for insufflation are : Sulphate of zinc, 
reduced with an equal part of sugar of milk or other inert substance. 
(The powder must be so fine that no grit is felt when rubbed between 
the fingers.) Tannic acid reduced to one-fourth or one-fifth, com- 
bined with iodoform, is useful on abraded or ulcerated surfaces. To 
this mixture, subnitrate or subcarbonate of bismuth may be added 
when indicated, and morphine also, for the relief of pain. Acetate 
of lead in proportion of 10 to 20 grains to \ ounce, combined with a 
little acetate of morphine, gives us what may be called a solid lead- 
water and laudanum. 

Nasal catarrh, if present, must be treated, otherwise the cure of the 
laryngitis will probably not be permanent. 

To prevent a return or the development of chronic laryngitis, the 
treatment should be followed up by tonics, as iron, quinine, strych- 
nine, cod-liver oil, together with a generous diet and exercise in the 
fresh air. Owing to the intimate relationship between the skin and 
mucous membranes of the nose and throat, the use of woollen under- 
wear is important. Friction to the skin and Turkish baths, espe- 
cially when a gouty or rheumatic ailment exists, may give good 
results. 

Should any permanent laryngeal thickening remain, potassium 
iodide, with or without arsenic, continued for a long time in very 
small doses, or one of the lithia waters, may be of service. 



Chronic Laryngitis. 

This form of laryngitis, like the subacute, is divided into the simple 
catarrhal or idiopathic, and the traumatic. The catarrhal form also 
includes those varieties in which a constitutional vice occurs, as 
phthisical, gouty, or syphilitic laryngitis. 

Chronic laryngitis may develop insidiously, or it may be the direct 
result of an acute or subacute attack. 

In a state of ordinary health, an attack of acute laryngitis runs a 
course of from one to two weeks, terminating in recovery. 

When from auy cause the vitality is reduced, convalescence may 
be retarded, and we have what is known as subacute laryngitis, a 
lower orade of inflammation than the acute form, but still tending to 



CHRONIC LARYNGITIS. 483 

recover under favorable conditions. A renewal of the attack at this 
stage may carry the patient beyond the' line where nature unaided 
is able to right herself and chronic laryngitis results. 

A lowered state of health is a predisposing cause, particularly 
when there is a lowered nervous tone. 

Overwork, business reverses, or severe mental strain ; a sedentary 
life, continued exposure to impure air, sewer gas, fumes from chem- 
icals, or the dust and fibres of cotton and woollen mills — all act as 
predisposing or exciting causes of chronic laryngitis. Loss of sleep, 
over-indulgence and excesses tend to produce the same result. In 
regard to the use of tobacco, cigarette smoking is more injurious than 
either the pipe or cigar, for the reason that the cigarette smoke is 
inhaled, and the irritating products resulting from the destructive 
distillation of the woody fibre are drawn directly into the larynx. 

Chronic laryngitis is essentially a disease of civilized life. One of 
its most common sources is found in mouth-breathing and its conse- 
quences. 

The nose is so constructed that a large surface of mucous mem- 
brane, warm and moist, comes into contact with the inspired air, 
imparting to it its warmth and moisture, while particles floating in 
the air adhere to the moist surface and are discharged with the flow 
of mucus which they excite. 

In mouth-breathing no such preparation of the air occurs, and 
the delicate mucous membrane of the larynx, subjected to this 
constant source of irritation, is kept in a congested condition. 

The symptoms of ordinary chronic laryngitis are hoarseness, dry- 
ness of the throat, tickling sensations, vague feelings of discomfort, 
a sense of constriction about the throat, and a dry, hacking cough. 
The expectoration is usually scanty and raised with difficulty. A 
profuse discharge from the vault of the pharynx, removed by hawk- 
ing, indicates more or less naso-pharyngeal catarrh. 

The mucous membrane in simple cases, as seen by the laryngo- 
scope, is redder than normal. The ventricular bands may be thick- 
ened until they nearly overlap the cords. The vocal cords vary in 
color from a muddy tinge to a deep livid red. The inflammation 
sometimes occurs in livid spots. 

Injection of the vocal cords may be marked, showing twigs of 
dilated bloodvessels running longitudinally. 

As the result of irritation occasionally a minute white fibrous 
swelling develops on the free edge of a vocal cord, or two may form 
directly opposite each other, interfering with the proper approxima- 
tion of the cords. They are usually mere points and the writer 
has only seen them occur in the throats of singers. They gradually 
become smaller under astringent applications and attention to hygiene. 

Finally, fissures or abrasions may occur in the larynx in chronic 
laryngitis, the common location being the inter-arytenoid space. A 
small laryngeal fissure is not always easily recognized. 



484 DISEASES. 

The mucous membrane at that point is usually darker than the 
surrounding tissue, and may be bathed in a muco-purulent secretion. 
In the morning, after considerable coughing, a small pellet, resem- 
bling boiled sago, which has formed during the night, may be coughed 
from this spot, 

When a fissure of this nature granulates it may give rise to many 
of the symptoms of laryngeal phthisis, diagnosis from which the 
laryngoscope alone clears up. 

The physician must strike at the root of the trouble by finding the 
cause and removing it. If due to faulty use of the voice, either in 
speaking or singing, proper training in its management and care will 
be productive of decided benefit. 

As far as possible, all sources of irritation should be removed. 
Relieve nasal obstruction, enlarged tonsils, or anything that prevents 
the free circulation of air through the nose, for we cannot look for a 
cure while mouth-breathing continues. 

Complete rest of the voice, with attention to the general health, 
will greatly relieve the throat in most instances ; but, unfortunately, 
the trouble usually returns on resuming the use of the voice. In 
fact, it is not always advisable for one who must use his voice again 
to prolong the rest indefinitely, for a throat accustomed to heavy 
demands is liable to stiffen under prolonged disuse, the voice never 
quite regaining its old power and flexibility. 

After the laryngitis has made decided improvement, the judicious 
use of the voice has seemed to the writer, in some instances, to have 
favored resolution, and to have kept the muscles from degenerating. 

Very much depends on local treatment in the cure of chronic 
laryngitis, and some of the directions given for treating sub-acute 
laryngitis apply here equally well. 

After cleansing the mucous membrane of the larynx from secre- 
tions, the use of astringent sprays gives excellent results. 

The insufflation into the larynx of astringent powders, as sulphate 
of zinc reduced one-half; or tannic acid one-fourth or one-sixth, 
combined with boracic acid, subuitrate of bismuth and sulphate of 
morphine, is useful in painful conditions. 

An excellent powder for protecting and covering raw or ulcerated 
surfaces is a modification of the formula known as " Ferrier's snuff :" 

R. — Morph. sulph. . . . . . . gr. v. 

Bismuth, submit 3lj ss - 

Pulv. acacise . gr. xxv. 

To this may be added iodoform, when indicated for ulcerations or 
abrasions. Indolent or granulating inter-arytenoid fissures should 
be touched with a strong solution of nitrate of silver applied by a 
brush attached to a bent probe, or a little of the pure salt or the 
" mitigated" stick fused on the end of a silver applicator. 



LEUCORRHCEA. 485 

This is by no means an easy operation to perform, as it is impor- 
tant to avoid touching any other part of the larynx, as this would 
increase the spasm which is liable to occur. 

Stimulating vapor inhalations, such as compound tincture of 
benzoin, tar, or cubebs, used as described for subacute laryngitis, 
give decided relief. 

Combine pleasant occupation in the open air or travel in a dry, 
bracing climate. As a rule, the air at the seashore is too moist for 
chronic laryngeal troubles. 

Sufferers from chronic laryngitis should always wear woollen 
underwear, and keep the skin and the secretions generally in a 
healthy condition. 

LEUCORRHCEA. 

This is a condition, vulgarly known as the " whites/' consisting 
in a hypersecretion from the glands, which pour out their contents 
into the vagina or the cervical canal of the uterus, or even into the 
cavity of this organ. 

It is a state dependent upon many causes for its existence, the 
chief of which are a condition of the system when it is " run down" 
from any cause, and prevented function of the glands or their sur- 
roundings. In some persons who seem perfectly strong and well 
it would appear to be due to an effort of the system to overcome 
plethora. The character of the discharge varies with almost every 
case. In some instances it is thick and tenacious, in others so liquid 
as to trickle down the limbs in a stream and greatly soil the cloth- 
ing. In most of the latter cases catarrh of the Fallopian tubes or 
ovarian irritation and tenderness will be present. Where the secre- 
tion is very thick and tenacious it generally arises from the cervical 
canal, while that from disorder of the vaginal wall alone, independent 
of other morbid conditions, may be one or the other. 

The treatment of these forms of leucorrhcea may be divided into 
two parts; one, that directed to the remedying of the morbid process 
through the use of drugs by the mouth, the other by their employ- 
ment locally. 

It is needless to state that in that form dependent upon excessive 
lactation or other exhausting manner of life, tonics of an active char- 
acter are needed. As a general rule anaemia will be present, and the 
following pill will be found of service : 

R. — Acid, arseniosi gr. ^ 

Ferri redactum . . . . . . . gr. ij. 

Quin. sulph. . . . • . . . gr. xx. 

M. Ft. in pil. No. xx. — S. One pill t. d. for an adult, after meals. 



486 DISEASES. 

Or, 

R .— Tr. ferri chlorid. f 3 j. 

Tr. cinchonse comp. . . . . . . fg ij. 

Tr. gentian, comp q. s. f ^ iv. 

M. — S. Dessertspoonful t. d. after meals. 1 

Sometimes equally small doses of the sulphate of iron are better 
for these purposes owing to its astringent properties, but when these 
preparations of iron are used, care must be taken that the bowels 
are kept active and that the stomach is not disordered. Associated 
with the use of these internal remedies should be a moderate amount 
of exercise and the avoidance of late hours and rich foods. 

The local applications which are of value in these states consist 
in counter-irritation and injections or painting with proper fluids. 
In the leucorrhoea dependent upon irritation of the ovaries with 
catarrh of the Fallopian tubes, the use of small blisters made by 
the employment of cantharidal collodion over the groin on either 
side is often accompanied by good results. At the same time the 
vaginal surfaces surrounding the cervix uteri may be painted with a 
mixture of iodine, carbolic acid, and chloral, such as is used by Dr. 
Goodell, as follows : 



J£. — Iodi resublimat 5jiv. 

Acid, carbol. crystal. \ __ ~. 

Chlorali / " * ' ' aa 3J- 

Kub the iodine and chloral in a glass mortar into a powder and add the car- 
bolic acid. S. Formula. To be used by the physician only. 

The following pill may also be employed : 

R . — Hydrarg. chlor. corros. ..... gr. £. 

M. Ft. in pil. No. xx. — S. One t. d. after meals. 

The remaining treatment of leucorrhoea consists in the use] of 
astringent injections. A very cheap astringent injection is rnadeHby 
adding 1 ounce of powdered white oak bark to each pint of water/or 
tannic acid and glycerin in the proportion of 1 ounce to 2 quarts of 
w T arm water. Ringer recommends the following : 

R. — Sodii bicarbonat. 3j. 

Tine, belladonnas . . . . . . fgij. 

Aquae. Oj. 

M. — S. Use as a vaginal wash. 

Where the discharge is foetid a solution of permanganate of potas- 
sium should be used as an injection in the strength of \ drachm to 1 
pint of water. Sometimes a tampon thoroughly saturated with a 
powder of iodoform and tannic acid, equal parts, and packed around 
a discharging uterine cervix, is of service. 

In the use of vaginal injections in females it is important to re- 

1 In both these prescriptions the small amount of iron and arsenic will probably be 
noted, but this is done advisedly, as iron and arsenic do as much good to the blood in 
small as in large amounts. (See Iron .) 



487 

member that they should be in large quantities. Nothing is more 
antagonistic to true asepsis than the usual manner in which these 
applications are made. Generally a pint of the solution is placed 
in a basin over which the woman squats and by means of a syringe 
forces the liquid iuto the vagina as fast as it runs out, thereby filling 
the syringe joints with the dissolved secretions and returning to the 
vagina as fast as they flow away the impurities which have left it. 
The only proper way to do is to have the solution in one basin to 
the extent of 1 gallon and for the patient to squat over a second 
basin into which the impure liquid may run. 

A very useful astringent injection may be made by ordering : 

R. — Zinc, sulphat f^j. 

Alumin. sulph f^j. 

Glycerine f^ v j- 

M. — S. A tablespoonful to each quart of water. 



LUMBAGO. 

This is a form of myalgia or muscular rheumatism of the muscles 
of the loins and small of the back, and is frequently the result of 
lifting heavy weights or results from other strains. In many cases 
acupuncture is very useful, particularly if the trouble is bilat- 
eral. Sometimes after its use the patient can straighten up at once 
and retain that position. In other instances antipyrine or antifebrine 
in 10 to 20 grain doses of the former and 4 to 8 grain doses of the 
latter are of service, and iodide of potassium and salicylic acid are 
not to be forgotten if the condition of the patient does not rapidly 
improve. Sometimes a hot foot-bath and a Dover's powder on going 
to bed will produce a cure, and ironing the back with an ordinary 
hot laundry iron at a proper heat, a piece of newspaper or cloth 
being placed over the skin under the iron, is very efficient. Some- 
times counter-irritation in the shape of a blister or a mustard plaster 
or capsicum draft will give relief. 

Where these measures fail the reverse treatment may be tried, such 
as an ice-bag, placed over the loins, or an ether spray turned on the 
part till the skin is greatly blanched. 



MALARIAL FEVER. 

(See Intermittent and Eemittent Fevers.) 

MANIA, ACUTE. 

Space is wanting to consider the thorough and complete treatment 
of mania as it comes to the neurologist. All that can be done here 



488 DISEASES. 

is to denote temporary measures suitable for cases which are brief 
in their course. 

In those cases which occur after confinement and are not supposed 
to be based upon permanent trouble, cimicifuga racemosa is said to 
be very useful in the dose of 20 to 30 drops of the fluid extract of 
cimicifuga three times a day, while for the rapid quieting of the 
patient we may use hyoscine hydrobromate in the dose of T ^ grain. 
In other instances, if the kidneys are healthy, full doses of chloral 
may be used, and if an active preparation of cannabis indica can be 
had at least 1 grain of the solid extract, or ] drachm of the tincture 
should be employed, and it will be found particularly serviceable if 
60 grains of one of the bromides can be combined with it. 

Where a patient suffering from mania is so violent that nothing 
can be done with him, he should be held and an emetic dose of ^ 
grain of apomorphiue be given hypodermically, to vomit and relax 
the muscular system, or he may be tied or anaesthetized sufficiently 
to enable the physician to administer proper remedies. Sometimes 
full doses of morphine are needful, and in others a cold douche to 
the head, the body being in hot water, is of service. 



MELANCHOLIA. 

This is not the place for a discussion of melancholia of so severe 
a form as to amount to insanity, since the treatment of this latter 
state is very various and largely dependent upon the skill of trained 
physicians who are alienists. 

There is one form of melancholia, however, which may often be 
rapidly relieved by a simple measure. It is that dependent upon 
the condition of the system in which oxaluria is present. When- 
ever an individual complains of melancholia the urine should be ex- 
amined, and if any oxalate crystals are found, dark-red, fresh nitro- 
muriatic acid should be given in the dose of 5 drops after each meal 
in a half tumblerful or more of water. In order to guard against 
error it is well to remember that pears, tomatoes, and cabbage, when 
taken as food, all cause the presence of oxalates in the urine for a 
short period. 

MENINGITIS, ACUTE. 

Meningitis is to be treated as in any other form of acute inflam- 
mation occurring in a sthenic or dynamic individual, and particu- 
larly does its treatment correspond to that of the other inflammations 
of large serous membranes, such as peritonitis or pleurisy. 

In the early stages the patient should receive sufficiently large 
doses of aconite or veratrum viride to impress strongly the circulatory 
system. These drugs have the power of producing such dilatation 



MENINGITIS, ACUTE. 489 

of the blood-paths throughout the body that the congested or in- 
flamed area is relieved of its excess of blood, because the pressure 
being less elsewhere it obeys the law that liquids always try to escape 
from pressure,, and so leaves the meninges of the brain for the vessels 
in the limbs and trunk. A good sized blister should always be 
placed at the nape of the neck as a counter-irritant to prevent 
effusion. 

The proper dose of veratrum viride in the form of the tincture is 
3 drops every hour until the skin becomes moist or nausea is devel- 
oped. 1 The tincture of aconite is also useful in full dose. If great 
arterial excitement is present venesection may be practised (see 
Bleeding), but veratrum viride or aconite is better, if it is at hand. 
Associated with these two drugs we should employ mercury and 
opium, the first for its antiphlogistic influence, the second for its 
power in allaying irritation. As a consequence we find that J 
grain of powdered opium and } grain of calomel may be given every 
hour until the full effect of the opium or mercury is manifested. 
In some instances the deodorized tincture of opium (Tinctura opii 
deodorata) is better than the crude drug, in the dose of 2 to 5 drops 
every two hours, or less. Sometimes belladonna is of great service, 
and this is particularly the case where the drugs already named are 
contra-indicated because of a condition of weakness or asthenia. In 
both conditions ergot is of value in allaying the congestion, but its 
period for exerting a favorable effect is not at the very first part of 
the attack, but a little later when the stage of exudation is at hand. 
During the first acute stage an ice-bag should be applied to the head, 
both for its local influence and antipyretic effect, and leeches may be 
put at the nape of the neck with advantage. As the disease advances 
and the nervous disorders of the affection become marked, nervous 
sedatives are required to allay the twitchings, muscular spasms, or 
convulsions, and for this purpose no drugs are to be compared to 
chloral and the bromides. 

The doses to be used vary with the violence of the symptoms, but 
it may be stated that the chloral should rarely, if ever, be used in 
doses above 10 grains, and the bromides from 5 to 40 grains. If 
coma comes on, a large blister should be applied to the nape of the 
neck. 

Quinine has been recommended in meningitis, but it is absolutely 
contra-indicated, as it predisposes to this condition. It may only be 
employed in convalescence and then used most carefully. 

The treatment of the second stage of meningitis must be necessarily 
supportive owing to the reaction consequent upon great nervous and 
arterial excitement. Under these circumstances the use of opium is 
still indicated, because it allays nervous unrest and supports the 

1 It is to be remembered that veratrum viride often causes nausea and even vomit- 
ing in susceptible persons, and in consequence must be carefully given in meningitis 
lest if vomiting come on the disease be made worse. 



490 DISEASES. 

system, partly by conserving the tissues and partly by inhibiting the 
waste of nervous force apt to occur at this time. Alcohol should 
be given with the food if weakness is present, and a very simple 
milk diet insisted upon. 

MIGRAINE. 

(See Neuralgia.) 

MYALGIA. 

Soreness of the muscles either on pressure or on movement may be 
dependent upon a number of causes such as strains, bruises, rheumatic 
taint, or inflammation due to a cold. Here, as in many other states, 
the treatment is to be divided into the external and the internal 
methods. Of the internal remedies the best are the salicylates or 
iodide of potassium, if rheumatism be at the base of the trouble. On 
the other hand, if a bruise or cold be the cause, the chloride of ammo- 
nium will be of service in 1 or 20 grain doses given in a solution 
with extract of liquorice (for prescription see Bronchitis). Other 
remedies which may be tried with a good chance of success are full 
doses of a good fluid extract of cimicifuga (20 drops to 1 drachm) or 
the citrate or acetate of potassium in 20 grain doses. 

The local medications are numerous, but only a few can be consid- 
ered as worthy of routine employment. The chief one is iodine, in 
the form of the pure ointment or diluted one-half with lard if the 
skin is easily injured. Another method is to employ a liniment, 
well rubbed in, made up as follows : 

R .— Tr. belladon f^j. 

Tr. aconit . . f^ij. 

Tr. opii . . f ^ ij. 

Liniment, saponis q. s. f,^vj. 

M. S. — Poison. To be used externally only as a liniment. 

Sometimes chloroform liniment is singularly successful, and poul- 
tices applied as hot as can be borne and covered by oil-silk and cotton 
to retain the heat, are often of great value. Massage or good rub- 
bing is also a sine qua non of good treatment in this state. 



NASAL CATARRH, ATROPHIC. 

[Synonym, Atrophic Rhinitis.) 

The atrophic or last stage of nasal catarrh, commonly known as 
dry eatarrh, is a natural sequence of the stage of hypertrophy ; 
although in exceptional instances the atrophic type has appeared 



NASAL CATARRH, ATROPHIC. 491 

from the start. Increased vascularity and over-stimulation of the 
hypertrophic stage lead to increased functional activity, and finally 
to exhaustion and atrophy of the tissues involved. (See page 492.) 

In atrophic nasal catarrh the nostrils are roomy and the mucous 
membrane red and shiny. The formation of connective tissue has, 
to a great degree, obliterated the delicate serous glands, and the dis- 
charge of mucus, no longer diluted, forms inspissated crusts, which 
adhere to the mucous membrane of the septum and turbinated bones. 

Areas of ulcerated or abraded membrane are disclosed upon re- 
moval of these adherent crusts. 

The turbinated boues are gradually absorbed and the secreting 
surface thereby much reduced. Sometimes the wasting is so great 
that the posterior wall of the pharynx is clearly visible from the 
front. The inspissated secretion may make a cast of the nostril, 
and as fresh layers form underneath the oldest part is raised until 
the whole interior of the nostril becomes a mass of decomposition, 
giving rise to an overpowering stench. This form of catarrh causes 
loss of the sense of smell, and the odor is not recognized by the 
patient himself. Ulceration or caries of the bony structure produces 
an odor even worse than the so-called ozcena. The pharynx suffers 
from the general wasting and presents a dry, varnished appearance 
called pharyngitis sicca, which is rather a symptom of nasal atrophy 
than a separate disease of the pharynx. 

The indications are the removal of all accumulations in the nose 
and naso-pharynx ; the healing of abraded or ulcerated surfaces ; 
the early removal of dead bone is imperative, and what secreting 
surface remains, as far as possible, must be stimulated to compensate, 
in a measure, for the glands that are hopelessly destroyed. In other 
words, our efforts are directed toward producing a compensatory 
hypertrophy of the glandular tissue that remains. Therefore, with 
the use of antisepsis we combine alteratives and local stimulation. 

Cleanse the nose thoroughly with the alkaline wash — Dobell's 
solution — warmed to increase its solvent power. To relieve the 
odor increase the amount of carbolic acid or substitute for it eucalyp- 
tol and thymol in the wash. Listerine contains both of these and 
may be added to the wash. Its own pungent odor masks somewhat 
the offensive odor. Permanganate of potassium may be used in 
weak solutions, but is painful except when sensation is entirely lost. 
Peroxide of hydrogen is recommended, but the writer has had no 
experience with it over such an extensive surface. 

The solutions are best applied by means of an atomizer or post- 
nasal syringe in the hands of the physician, or by snuffing from the 
hand or cup at the patient's home. 

The odor, if due to decomposition, is much relieved as soon as the 
passages are clear. The discharge must never be allowed to re-accu- 
mulate, or much time will be lost. 

Ulcerations require local stimulation by a strong solution of nitrate 



492 DISEASES. 

of silver or a superficial application of the flat surface of the galvano- 
cautery heated to a dull redness. Remove necrosed bone, which is 
often found detached in the nostril. 

Judiciously combine local stimulants with alteratives. Powders 
of nitrate of silver, in starch, varying in strength from 1 to 10 grains 
to 2J drachms of the latter, may be blown into the nostrils by means 
of an insufflator ; to cover gently the whole surface with a thin layer 
use it only of sufficient strength to be slightly felt. Nitrate of silver 
in solutions 1 to 10 grains to 1 fluidounce, at other times gives better 
results when applied to the mucous membrane. Avoid over-stimu- 
lating and so exhausting the glands we wish to strengthen. The 
use of alteratives may alternate with the silver salt and iodide of 
poassium, and this may be done by using solutions of iodine and 
glycerin, as recommended for hypertrophic nasal catarrh. Internally, 
the physician should employ iodide of potassium to increase nasal 
secretion, mucous membrane stimulants and tonics, and pay attention 
to the activity of the skin. 



NASAL CATARRH, CHRONIC. 

Chronic nasal catarrh is essentially a disease of civilization, which 
may occur at any period of life, but more commonly develops from 
youth to early adult life. 

Although more prevalent among the upper classes, in the lower 
ranks it most frequently reaches its later stages and its worst forms. 
This does not result from lack of opportunity for treatment, but 
from the ignorance or indifference which this class show to diseases 
while there is no suffering and no interference with business. 

Etiology. — It is largely due to our artificial mode of life, and its 
causes do not differ essentially from those which give rise to chronic 
inflammation in other parts of the upper air-passages, as in chronic 
laryngitis and pharyngitis. 

These diseases may accompany or be developed by nasal catarrh, 
and when present have an important bearing on its treatment. 

Continued exposure to the action of irritants of any kind of vari- 
ous substances, in the form of dust or particles floating in the air, 
keep the mucous membranes in a state of constant irritation. A low 
grade of inflammation is established, resulting in permanent thicken- 
ing of the mucous membrane, of the submucous connective tissue, 
with dilatation or actual hypertrophy of the erectile tissue covering 
the turbinated bones. The swollen tissues obstruct the passage of 
air through the nostrils, and mouth-breathing results, with its train 
of symptoms. 

The most common cause of catarrh is found in repeated attacks of 
coryza, each attack increasing the thickening of the mucous mem- 
branes and narrowing the breathing space. 



NASAL CATARRH, CHRONIC. 493 

Nasal catarrh, in its course, passes through three stages or periods, 
namely, the stage of coryza or acute nasal catarrh, and the chronic 
stages known as hypertrophic and atrophic nasal catarrh. (Page 490.) 

Coryza, or cold in the head, is not strictly a stage of nasal catarrh, 
but, as stated elsewhere, is an acute inflammation of the nasal mucous 
membranes, generally running a definite course and terminating iu 
recovery in a week or ten days. Its chief clinical importance, how- 
ever, is derived from its tendency, when the vitality is reduced or 
recovery is retarded, to pass into a chronic stage which, to all 
intents, is identical with the hypertrophic stage of nasal catarrh. 
The line of demarcation is not clearly drawn between these two dis- 
eases or stages, nor can we locate with absolute certainty the point 
where acute coryza becomes hypertrophic nasal catarrh. 

Atrophic nasal catarrh commonly develops from the hypertrophic 
stage, though occasionally the disease takes this form from the begin- 
ning. Its symptoms are essentially different from the other stages, 
being characterized by functional inactivity and derangement in place 
of over-stimulation in the hypertrophic stage. 

Hypertrophic nasal catarrh commonly has its origin in a neglected 
cold in the head, or in a series of colds occurring in rapid succession, 
keeping the nose in a congested state until the erectile tissue covering 
the turbinated bones loses in a measure its power of contracting, and, 
impinging on the calibre of the nostrils, becomes a source of perma- 
nent obstruction to breathing. 

As the disease progresses there is increased susceptibility to cold. 
Slight exposure produces a stuffy feeling in the nose. The nostrils 
may become completely occluded ; usually, however, only one side 
at a time is obstructed at first ; the obstruction showing a tendency to 
change sides. This change is most noticeable in turning in bed, the 
lower side usually stopping, and on changing the position the obstruc- 
tion is reversed, the clearing being accompanied by a crackling sensa- 
tion. A slight tickling cough and tendency to clear the throat in the 
mornings may result from irritation of the pharynx or larynx. 

The nasal obstruction, generally greatest at night, causes restless, 
troubled sleep, while the mouth-breathing leaves the tongue dry and 
coated in the morning. A dull, frontal headache, due to reflex irri- 
tation from intranasal pressure, is not uncommon. Unusual irrita- 
bility of the mucous membranes may result in frequent attacks of 
sneezing or in a free watery secretion, which is more active in cold 
weather, appearing as a drop of water, resembling a bead at the end 
of the nostril, or dripping from the nose in leaning forward. 

In patients of a still more neurotic type, attacks resembling acute 
coryza occur without a moment's warning, and subside as quickly as. 
they come. The nose at such times becomes stopped up to an 
oppressive degree, with free secretion, with or without violent sneezing. 

Such attacks are precipitated by exposure to a close or impure 
atmosphere or to dampness, especially at dusk when the dew is fall- 



494 DISEASES. 

ing or when the patient is fatigued. The voice becomes husky or 
altered in character from loss of nasal resonance. Aversion to com- 
pany results, and the patient becomes morose and moody. Catarrh 
of the middle ear is liable to occur. Conditions of this nature occupy 
a position closely allied to asthma or hay- fever. 

The rather minute consideration of this class of disorders is war- 
ranted by the important position they occupy on the border-land 
between catarrhal affections and organic diseases of the nervous sys- 
tem, and their important bearing in diagnosis and treatment. 

During the early stage of hypertrophic rhinitis, on inspection of 
the anterior nasal passages, all the tissues appear red and highly 
vascular. Along the surface and margin of the lower, and perhaps 
the middle, turbinated bones the tissues are swollen and puffy, and, 
in severe cases these puffy bags adapt themselves to the shape of the 
nostril, completely closing the passage-way. This does not often 
completely close both sides, except during an acute attack of coryza. 
One or other side, as a rule, remains open, with a tendency for the 
obstruction to reverse sides. The nervous impression produced by 
examination may cause temporary contraction of and clearing of 
both sides, which, unfortunately, is soon as bad as ever. 

The swellings, as described elsewhere, consist of cavernous blood- 
vessel tissue, which has the property of filling with blood and erect- 
ing, under stimulus. These swellings on the turbinated bones are 
known as hypertrophies, although at this stage they contain little 
hypertrophied tissue, but are, more strictly, bags of erectile tissue 
which have lost the power of contracting. They readily disappear 
upon pressure by means of a probe, but return at once when the 
pressure is withdrawn. Application of cocaine (4 per cent, solu- 
tion) produces some contraction, benumbing and blanching the tis- 
sues at the same time. 

The power cocaine possesses, of contracting hypertrophied tissue, 
is useful for purposes of diagnosis in hypertrophic nasal catarrh. 
By its use we may readily distinguish tumors, or bony or cartilagin- 
ous growths, from the erectile tissue. 

The long continuation of a low grade of inflammation favors the 
formation of connective tissue and actual hypertrophy of the turbin- 
ated tissues, which become larger and firmer, and do not completely 
disappear under pressure from a probe. At the same time a pro- 
gresssive increase in the nasal obstruction is observed. 

A rhinoscopic view posteriorly reveals a similar state of affairs, 
and a hypertrophy developing on the middle or lower turbinated 
bone, rarely on the upper. At this position the hypertrophy appears 
as a round, globular tumor, extending backward toward the vault of 
the pharynx. It is sometimes sessile, but often has a slight constric- 
tion at its attachment to the turbinated bone. It occasionally is pale 
and covered with mucus — indeed, a collection of mucus may be mis- 
taken for a hypertrophy. But cleansing the nose with a solution 



NASAL CATARRH, CHRONIC. 495 

sprayed by means of an atomizer directed through the nose from the 
front, or by a post-nasal syringe from behind, clears the diagnosis. 

At other times a posterior hypertrophy becomes engorged with 
blood, and presents a deep purple color, resembling, in size and shape, 
a red raspberry. 

Enlarged pharyngeal tonsils produce decided obstruction poste- 
riorly, and, by the secretion of large quantities of mucus, cause a 
constant feeling of fulness, with a desire to " hawk and spit." 

An enlarged pharyngeal tonsil is recognized as a soft, spongy mass 
in the vault of the pharynx. Occasionally it hangs down in festoons 
which resemble somewhat stalactites hanging from the roof of a cave. 
Should one of these stalactites become eroded it may cause frequent 
and alarming hemorrhages. 

Hypertrophy of the pharyngeal tonsil is more common in children 
than in adults and frequently occurs in connection with hypertrophied 
faucial tonsils or in conjunction with adenitis, elsewhere resulting 
from diphtheria or scarlet fever, or as part of a strumous diathesis. 

Hypertrophied tonsil is a fruitful source of deafness in children, 
as it may become large enough to interfere with the passage of air 
through the Eustachian tube or cause extension of catarrh to the 
middle ear. 

When a child is too small to permit a rhinoscopic examination 
the presence of an enlarged pharyngeal tonsil may be felt by intro- 
ducing the index finger through the mouth up behind the soft palate, 
taking care that the finger is protected from biting by the child's 
sharp teeth. 

It is well to educate the finger to recognize the size and shape of 
the naso-pharynx, although a disagreeable performance, for it may 
aid materially in outlining the structure, consistency, or point of 
attachment of tumors projecting from the nose into this space, or 
even assist in engaging a large growth in the loop of wire from a 
snare introduced through the nose. The ear should be educated to 
recognize the different effects produced on the voice by obstructions 
in the front or back of the nose and so to assist the eye in diagnosis. 

Occlusion of the nostrils, if well in front, gives a nasal sound to 
the voice from the pent-up vibrations in the nose and naso-pharynx. 
An obstruction at the back of the nose deadens the voice, interfering 
with its carrying power, preventing the voice being heard at any dis- 
tance from the speaker. The voice, to use a technical term, loses its 
timbre, and should it be used to any extent results in chronic laryn- 
gitis. The extra pressure injures the larynx, tires the throat, with- 
out increasing the carrying power. 

The pathological changes occurring in hypertrophic nasal catarrh 
do not differ materially from similar changes occurring in catarrhal 
inflammations elsewhere. In treating catarrh, find the cause, and if 
possible remove it. Great assistance in this direction may follow 
careful inquiry into the occupation and environment of the patient. 



496 DISEASES. 

The mucous membranes in hypertrophic nasal catarrh, as stated 
above, are in a condition of increased vascularity. The tissues are 
red and swollen, especially over the turbinated bones, where the sub- 
mucous connective tissue has increased to the extent of forming one 
or more red puffy cushions which almost or completely obstruct the 
passage-way. These cushions are more or less elastic and may be 
pressed partly away by means of a probe, but immediately return on 
removing pressure. Originally composed of erectile, spongy tissue 
with the power of contracting and dilating, they now remain perma- 
nently enlarged or hypertrophied. 

The difference between nasal catarrh and simple catarrh occurring 
in other places, is chiefly the result of location. The nasal mucous 
membranes are surrounded by bony walls which limit the power of 
swelling to one direction, namely, toward the centre. This affects 
the main function of the nose, that of respiration, and obstructed 
respiration leads at once to a train of symptoms, not of catarrh, but 
directly or indirectly the result of catarrh. 

Swelling of the turbinated tissue and nasal obstruction are early 
symptoms of hypertrophic nasal catarrh. The change in functional 
activity which is caused by obstruction to respiration, and the nervous 
irritation resulting from pressure, sooner or later produce permanent 
injury, either local or reflex. 

The first indications for treatment are the reduction of inflamma- 
tion and restoration of the breathing space. 

As the chief function of the nose is respiratory, the reestablish- 
ment of free nasal respiration, combined with the liberal use of anti- 
septic washes, will lessen the inflammation and irritation and produce 
a healthier state of the secretions. 

The writer places cleanliness at the head of the list of remedial 
measures. The alkaline wash recommended on page 389, sprayed 
into the nose by a hand atomizer, or gently snuffed from the palm of 
the hand or from a small cup, gives good results. The hand warms 
the solution slightly, but when snuffed from a cup the solution 
should be artificially warmed. The wash may be used two or more 
times a day. 

The nasal douche should never be used where there is nasal 
obstruction, on account of the risk of forcing the solution into the 
Eustachian tube and causing catarrh of the middle ear. 

In addition to the antiseptic wash, where the mucous membrane 
is congested and irritable, the treatment recommended for coryza 
may be instituted for a few days with good results. A solution 
composed of equal parts of distilled extract of hamamelis and 
water, or a dilute solution of hydrastis may be sprayed into the nose 
during the acute stage. 

A little later, a spray of ferric alum, 5 grains to the ounce, or 
the preparation of iodoform known as " Bolton's solution," may be 
applied carefully, as a spray, by the physician. 



NEUKALGIA. 497 

It is not advisable to use alum in any considerable strength in 
the nose, as its continued use is liable to impair the sense of smell. 

The alterative and absorbent action of iodine makes it a valuable 
remedy for local application in chronic nasal catarrh. Combine it 
with glycerin in the strength of 6 or 8 grains to the ounce, with 
enough potassium iodide to make a solution. Apply this by means 
of a piece of absorbent cotton on the end of an applicator, along the 
floor of the nose, until it reaches the pharynx. It is needless to say 
that such an application as this should be made with the utmost 
gentleness. The cotton should project beyond the probe, and care 
should be taken to avoid bruising the tissues. 

After the acute stage has subsided, as shown by the disappearance 
of the livid color and lessened sensibility, any remaining hypertro- 
phic tissue should be removed by a snare or the galvano-cautery. 



NEURALGIA. 

Like headache, neuralgia gives rise to most of the suffering experi- 
enced by active persons who are not sick enough for bed or who are 
confined to bed by other diseases. It affects members of every walk 
of life, and may be so severe as entirely to incapacitate the most 
powerful of men. 

The causes of neuralgia are very various, but they may be 
briefly stated to depend chiefly upon malnutrition, over-work, 
nervous excitement, with consequent reaction, and to reflex irritation 
from diseased organs, as in the case of supra-orbital neuralgia from 
eye-strain, or ovarian neuralgia from uterine inflammation. Nerves 
functionally diseased are always more or less active than normal ; that 
is, hyper-excited or A?/po-excited, below or above par. In both cases 
they must be brought back to their normal tone by appropriate rem- 
edies, and these consist in nervous excitants and nervous sedatives. 
To give a nerve already depressed the additional depression of a 
bromide, or a nerve excited the additional excitement of strychnine 
is absurd. 

From what has just been said it becomes evident that the physician 
must always determine the condition of the system of his patient, 
and the causes of that condition, before administering remedies. 

The treatment of this disease, from its curative standpoint, may 
be divided into the use of tonics, nutritives, and palliatives. 

Where neuralgia is associated with anaemia no hope of permanent 
relief can be looked for, unless iron and arsenic are used, until the 
anaemia is cured, and it is often necessary to combine with these 
drugs the use of cod-liver oil and bitter tonics. These are the cases, 
too, in which mix vomica or strychnine raise the depressed nerves to 
increased activity and bring relief. How they do this is not perfectly 

32 



498 DISEASES. 

known, but we know enough to recognize one or two important facts. 
Strychnine is certainly a nervous stimulant, and is also a stimulant 
to the anterior columns of the spinal cord. It also acts upon the 
trophic centres in the anterior cornua of the spinal cord, and by 
stimulating these centres increases the nutrition of the tributary 
nerve fibres. 

It is needless to state that the neuralgias of syphilis and scrofulosis 
are to be treated by the specific remedies directed to the cure of these 
causative affections, while at the same time the varying symptoms are 
carefully controlled by appropriate palliatives. 

Where nervous exhaustion causes neuralgia phosphorus is a useful 
remedy, particularly in those cases which are convalescing from acute 
fevers. 

Sometimes malarial poisoning produces a violent form of supra- 
orbital pain known as " brow ague," which is to be relieved, not by 
ordinary remedies, but by large doses of quinine. 

The relief of the states producing neuralgia having been spoken 
of, it yet remains for us to cousider the measures to be adopted for 
the cure of an attack. Fortunately, the recent advances of thera- 
peutic study have placed in our hands a large list of drugs not apt to 
produce a habit after prolonged use, comparatively safe while yet 
active, and not of disagreeable taste or general effect. By these 
terms the writer refers to antipyrine, acetanilide, and phenacetin, all 
of which possess wonderful power in the alleviation of pain depen- 
dent upon true nervous involvement, but in order to avoid failure in 
the use of these drugs in the relief of headache we must remem ber 
always that their field of service is that of neuralgic pain, not other 
pains. Antipyrine is to be used iu the dose of 5 to 20 grains for 
ordinary neuralgia, or the pain arising from the crisis of locomotor 
ataxia, acetanilide in the dose of 3 to 8 grains for the same purposes, 
and phenacetin in the same amount as acetanilide. 

Upon these remedies combined with caffeine and the bromides, 
according to circumstances, we now depend, and the following pre- 
scriptions will be found of service : 

£.— Antipyrine 3J. 

Caffein. citrat. gr. xx. 

M. — Ft. in chart No. x. S. One every thirty minutes till relieved. 

The following may be of use also : 

£.— Antipyrine gj. 

Potas. bromid. . . . . . . . giij. 

M. — Ft. in chart No. x. S. One every thirty minutes till relieved. 

Or when the caffeine in the first prescription causes nervousness : 

R.— Antipyrine • 3J- 

Caffein. citrat ' . . . gr. x. 

Potas. brom. 3 ij j- 

M. — Ft. in chart No. x. S. One as above. 



499 

In any one of these prescriptions acetanilide or phenacetin may be 
substituted for the antipyrine. 

An effective remedy in some cases of brow neuralgia is croton 
chloral in from 5 to 20 grain doses in pills of 5 grains. 

A very large number of local applications have been used with 
success in obstinate neuralgias and other cases not so difficult of cure. 
Cocaine cannot be applied, as it does not penetrate the skin, but relief 
can sometimes be obtained by the local use of the oleate of aeon i tine 
painted over the spot if it be limited in area. Too much of this 
alkaloid cannot be applied, lest poisoning by absorption occur. 

Where the nerve is very superficial it can often be treated by cold 
with great success. This is accomplished by freezing the parts with 
an ether or rhigolene spray, or by the application of a small package 
of finely chopped ice and salt. Within the last few years the treat- 
ment of neuralgia by kataphoresis (see p. 326) has come into promi- 
nence, and consists in the use of some local anaesthetic, such as chloro- 
form, which is applied over the part on a small piece of lint, and a 
rapidly interrupted current used through the pledget. Under these 
circumstances the anaesthetic passes through the skin and affects 
the nerve. 

A very useful local injection in localized neuralgia is -§• to \ of a 
grain of morphine, but the danger of beginning the morphine habit 
is to be remembered when treating chronic cases. Sometimes acu- 
puncture (see p. 297) is of service, and the surgeon may be called 
upon to stretch the nerve or to do a neurectomy. 

There still remains to be considered a form of neuralgia generally 
known as migraine. This affection is very severe in its manifesta- 
tions, and is often most obstinate in yielding to treatment. Com- 
monly it is associated with eye-strain or cerebral disease and other 
similar causes, and these must be removed before a cure is entirely 
effected. The best treatment of most of these attacks is the use of 
20 drops of the tincture of cannabis indica every hour, if a good 
preparation can be had, or by the use of J to J a grain of the solid 
extract everv two hours. 



NIPPLES, SORE. 

Whenever the nipples become sore, so that it is impossible for the 
mother to allow the child to nurse, a solution of cocaine of the 
strength of 4 grains to the ounce should be applied to the part, and 
washed off carefully just before the child sucks. Following the 
nursing a solution of boracic acid of the strength of 20 grains to the 
ounce of water or mucilage of acacia may be used over the part, the 
nipple being thoroughly dried beforehand. Where the fissures are 
deep and slow to heal, the tip of a stick of silver nitrate may be 



500 DISEASES. 

applied to them with advantage. Other practitioners employ tinc- 
ture of benzoin over the inflamed part, and a glycerite of tannin is 
often of value. Cleanliness, dryness, and care of the breast previous 
to parturition do much toward preventing the condition. 

Sometimes it is necessary to use a breast-pump or nipple-shield 
before a cure can be effected. 



OBESITY. 

Whenever an excess of fat accumulates in the body as part of its 
substance, various discomforts, both mental and physical, arise, and, 
in addition, the normal functions of all the parts are so disturbed or 
interfered with that the continuance of health is impossible. In 
many cases the deposition of fat about the heart or between its fibres 
results in serious symptoms, and breathlessness on exertion is pro- 
duced by the obstruction which is offered to the free movements of 
the diaphragm, owing to masses of omental fat aided by the great 
weight and bulk of the body requiring severe muscular effort. It is 
worthy of note also that a layer of fat over the body increases the 
vascular surface in the body very greatly, and in consequence gives 
the heart the labor of supplying a larger number of bloodvessels. 

The causes of obesity are numerous. In many families there is 
an inherited tendency, while in others only individuals are affected. 
These persons are fat because their systems naturally tend to the 
deposit of obese materials in the same way that the members of one 
family have large bones and another small bones. The etiology o± 
obesity, outside of the causes first named, are very numerous, but 
the chief one is over-indulgence in food. 

Just at this point it is not out of place to state exactly what over- 
indulgence in food means. Every individual living is a law unto 
himself in regard to the amount of food which is consumed and 
ingested. One often sees large, powerful, wiry men, who eat little, 
sit beside others, not so powerful or large, who eat excessively and 
who apparently do not suffer from indigestion in consequence. 
Neither of these two groups become excessively fat, because one 
represents a grate which burns its fuel so that there is no waste, 
while the other resembles a grate in which there is always a residue 
of unburnt coal, which is cast out with the ashes as effete 
matter. As different engines of the same build burn varying 
amounts of coal, so do different men use different amounts of food. 
No stated amount of food can be set down as a man's daily portion, 
until his case is studied, but it is important to remember that the 
quantity of food is generally in direct ratio to the severity of the toil, 
and that a man who loafs about a club, or a takes life easy/' often 
eats more than a day laborer, of far richer foods too, and wonders 



OBESITY. 501 

why he gets stout. In Dearly every case of obesity not dependent 
upon gross disorder of the trophic nerves, over-indulgence in foods 
is the cause. To some this may seem absurd, aud the patient will 
say that he eats just enough to keep him from feeliug empty between 
meals, but this does not alter the case in the least. The proper 
amount of food for a man is not what his appetite or gastric viscus 
calls for, but what his system needs. To this further reference will 
be made when cousideriug the diet for obesity, found below. 

The very presence of fat aids in the deposition of it, for, by acting 
as a non-conducting pad all over the body, it prevents the dissipa- 
tion of heat, and so decreases the combustion of those substances 
which, when not used for the manufacture of heat, are deposited as 
fat. Again, we nearly always find that obese persons are users of 
alcohol with their food, thereby increasing the fat in their bodies, for 
finding that they cannot digest all the substances which greediness 
makes them swallow, they take alcohol to stimulate their digestive 
apparatus to increased efforts and assimilation. Further than this, 
alcohol adds force to the body, and preserves the tissues by substi- 
tuting itself in the oxidizing processes. 

We find, therefore, that three great causes are active in producing 
corpulence in many cases, namely: heredity, over-indulgence in food, 
and lack of exercise, which is one of the means by which over- 
indulgence is produced — i. e., less exercise, less food needed, but often 
more eaten. 

The treatment of corpulence rests solely upon the conditions 
named. In all instances the diet is the important point for the 
bestowal of care. Reference has been made above to the fact that 
the needs of the system are the criterion by which we judge the 
amount of food necessary to each case, not the sensations in the 
stomach. The use of coca by the natives of South America enables 
them to withstand hunger and deprivation, not because it affords 
tissue to the body, but because it paralyzes the sensory nerves in the 
stomach, aud relieves the sensation of hollowness or weakness which 
we are accustomed to overcome in this country, in the absence of 
food, by tightening our belts. To understand this clearly, we must 
recollect that the system keeps its shares of force in the same way as 
a careful speculator keeps his shares of stock, namely, one part in 
active use for speculation, the other half for reserve in case of need. 
In health the stomach begins to "feel hungry " as soon as the specu- 
lative shares of force are nearly used, in order to cause the ingestion 
of more food and to preserve the " sinking fund " intact. It 
becomes evident, therefore, that the mere presence of hunger is 
purely a symptom, not an indication of the necessity of food, for, if 
it were, the consumptive would be notorious for his appetite, instead 
of being noteworthy for his anorexia 

The food of the patient suffering from obesity is to be cut down 
gradually, and the character of it arranged so that, though its bulk 



502 DISEASES. 

be great, its nutritive properties be small. Beef and other meats are 
concentrated foods containing much nourishment in a small space, 
while lettuce, spinach, cabbage, and nearly all vegetables, except roots 
or tubes contain a large amount of fibre useless to the body. By the 
use of a carefully arranged vegetable diet in obesity, we cut down 
the actual amount of food absorbed, and, by its bulk, keep the 
stomach so busy at sifting the nutritious from the non-nutritious 
materials that hunger is not felt, because another meal-time is reached 
almost before the food of the first is gotten away with. We find, 
therefore, that the diet for the reduction of corpulence may consist 
chiefly of bulky vegetables, but not too exclusively of any one article 
or set of articles. Heretofore it has been thought that proteids 
(meats, eggs, etc.) should be used to take the place of all hydrocar- 
bons or carbohydrates (fats, starches, and sugars), but this is not 
physiologically correct, as both forms of food are always needed for 
health, and it has been found that proteids may be converted into 
fats in the body. 

The following bill of fare will be found of service in obesity : 

Breakfast : One or two cups of coffee or tea, without milk or sugar, 
but sweetened with a grain or two of saccharin. Three ounces ot 
toasted or ordinary white bread or six ounces of bran bread. Enough 
butter may be used to make the bread palatable, not more than one 
ounce. Sliced raw tomatoes with vinegar, or cooked tomatoes with- 
out any sugar or fats. This diet may be varied by the use of salt or 
fresh fish either at breakfast or at dinner. 

Noon meal (dinner) : One soup-plate of bouillon, consomme, St. 
Julien or other thin soup, or Liebig's or Johnston's beef essence, 
followed by one piece of the white meat of any form of bird or fowl. 
Sometimes a small piece, the size of one's hand, of rare beef or 
mutton, but no fat, may be allowed, and this be accompanied by 
string beans, celery stewed or raw, spinach, kale, cabbage, beans, 
asparagus, leeks, and young onions. Following this, lettuce with 
vinegar and a little olive oil (to make a French dressing), a cup of 
black coffee or one of tea and a little acid fruit, such as some sour 
grapes, tamarinds, and sour oranges, or lemons, may be taken, and 
followed by a cigar or cigarette. 

Supper should consist of one or two soft-boiled eggs, which may 
also be poached, but not fried, a few ounces of bran bread, some salad 
and fruit, and perhaps a glass or two of light, dry (not sweet) wine, 
if the patient is accustomed to its use. 

Before going to bed, to avoid discomfort from a sensation of hunger 
during the night, the patient may take a meal of ponada or soak 
Graham or bran crackers or biscuits in water and flavor the mass 
with salt and pepper. 

The reduction of diet is generally best accomplished slowly, and 
should be accompanied by measures devoted to the destruction of the 



PERICARDITIS. 503 

fat present for the support of the body. Thus the patient should not 
be too heavily clad, either day or night, should use exercise, daily 
becoming more severe, and should drink freely of water, provided 
that sweating is established sufficiently freely to prevent the accumu- 
lation of the liquid in the vessels and tissues. 

Very often a cold bath will, by its disipation of heat, cause de- 
struction of fat, which will be burnt up in the body in the manufacture 
of heat units to maintain the temperature, and if the patient is not 
too anaemic and stands cold well, they should be repeated each day, 
or a Turkish bath used instead. 

The bowels should be kept active by laxative fruits or purges, 
but if liquids taken in drink are not eliminated rapidly, saline purges 
are useful, since if the bloodvessels are engorged, the circulation in 
the capillaries is slow and a deposit of fat is apt to result. 

AVhere proper exercise is impossible, massage, electricity, passive 
exertion, and an absolute skimmed-milk diet may be resorted to, par- 
ticularly in those persons known as " fat ansemics " who have not 
enough red corpuscles in their blood to carry sufficient oxygen to the 
tissues to complete oxidation. 



PERICARDITIS. 



Inflammation of the pericardial sac is a frequent occurrence, and 
requires prompt treatment. If the case be sthenic and is seen early, 
five to ten leeches may be placed over the prsecordiurn, and at the 
same time sufficiently large doses of veratrum viride resorted to, to 
impress the circulation, and by the dilatation of the bloodvessels to 
draw off the blood from the inflamed area. 

Where the case passes from the acute stage of inflammation to that 
in which effusion takes place, the treatment changes at once, and be- 
comes supportive if the system shows signs of failure. The friction 
sounds of the first stage are now lost and the heart sounds may be 
feeble or muffled in tone, by reason of the effusion present. To pre- 
vent the outpouring of a plastic exudate capable of undergoing 
organization and forming adhesions, calomel should be given in J 
grain doses every hour, combined with enough opium to prevent 
purgation. Digitalis, alcohol, or caffeine may be used if the heart 
shows signs of failure, and if the effusion is sufficient to endanger 
life, it should be tapped and aspirated away very gradually. In 
other cases it is only necessary to administer hydragogue purges, such 
as jalap, 20 grains of the compound jalap powder, or elaterium, ^ 
grain, or a saline purgative in concentrated form, before breakfast. 
Often a blister over the preecordium is of service. 



504 DISEASES 



PERITONITIS, ACUTE. 

An inflammation of the peritoneum, as in the case of any serous 
membrane, may be either sthenic and fibrinous or asthenic and serous. 
The same rules hold therefore in this case as in all forms of inflam- 
mation, namely, that circulatory depressants are only to be used in 
the first type and followed, if needed, by stimulants ; whereas, in the 
asthenic class the use of stimulants is called for at once and depress- 
ants are contra-indicated. Fur many years the profession have rec- 
ognized opium and belladonna, particularly the former, as the most 
universally applicable remedies and best curative drugs, for cases of 
peritoneal inflammation, and while a new school of treatment in this 
disease has arisen, it has only proved itself of value in a number ot 
cases. 

Remembering constantly that peritonitis is an inflammation, and 
as an inflammation therefore must be so treated, the course of treat- 
ment pursued by the physician is by no means complicated. While 
the use of veratrum viride may be resorted to, where the patient is 
strong and the pulse hard and tense, aconite may perhaps in such 
cases be better for the double reason that vomiting is apt to occur of 
itself and may be induced by the veratrum viride, while aconite de- 
cidedly prevents any such tendencies. This is important in view of 
the fact that vomiting always is to be avoided, lest the retching in- 
crease the peritoneal inflammation. If vomiting is present, it and 
the pain should be controlled by the use of large doses of opium and 
belladonna, say J grain of the extract of each to an adult, and be 
accompanied by the application of leeches to the abdominal wall in 
large numbers amounting to 10 to 30. If these cannot be had, a 
mustard plaster may be used. If the vomiting is too severe to take 
the drugs by the mouth, they must be given by the rectum in J pint 
of starch-water, laudanum and the tincture of belladonna being em- 
ployed in the proportion of 1 drachm each. 

Opium is always well borne in full dose by those suffering severe 
pain, and it seems to be particularly well borne in peritonitis. The 
use of the drug here, as everywhere else in medicine, is not governed 
by the amount in grains which has been used, but by the effects which 
it produces. These drugs, unlike the depressants and stimulants, 
mav be used in all forms of peritonitis and in all stages if called for, 
but the leeches and counter-irritation are limited in their use to the 
early periods of the attack. 

The use of calomel in peritonitis is highly praised by some and 
decried by others, largely because its proper sphere is not recognized. 
Mercury does good only in the severe, acute forms of peritonitis 
where the disease arises from traumatism or other cause and is not 
to be used for the liquefaction or changing of a fibrinous exudate into 
an exudate incapable of undergoing organization. 



PERITONITIS, ACUTE. 505 

The remaining directions are absolute rest, which is nearly always 
adhered to voluntarily by the patient owing to the pain, and the use 
of small quantities of predigested — that is, pancreatized milk — given 
frequently. 

Often in peritonitis the inflammation extends to the bowels and 
paralysis of their muscular fibres occurs. As a result of this, obsti- 
nate constipation ensues which is not to be overcome by purges, 
which if mild will not act, and if severe are dangerous, but by the 
use of belladonna and opium already spoken of. The rationale of 
this treatment in the light of our present physiological knowledge 
is not far to seek. Belladonna acts as an antispasmodic upon all 
uustriped muscular fibre, and in the large doses here given depresses 
the peripheral ends of the splanchnic or inhibitory intestinal nerves. 
In this way the muscular fibres which are in spasm are relaxed and 
the peristaltic waves set free. The value of the opium also is ap- 
parent, for it allays irritation and prevents the reflex muscular spasm 
dependent upon the pain and inflammation. Obstinate constipation 
after the ingestion of irritant foods, such as putrid meat, will often 
be relieved by opium and belladonna as effectively as if the patient 
was purged by an ordinary purgative. 

Very frequently in acute peritonitis tympanites becomes not only 
a very painful, but even a dangerous symptom, the distention of the 
belly being very great. This may be greatly relieved by the em- 
ployment of turpentine stupes (see Turpentine, p. 288), and in some 
cases by the rectal injection of milk of asafcetida, or better still, tur- 
pentine, 1 drachm ; milk of asafoetida, 3 ounces, and w r arm water, 4 
ounces. 

Not content with having made a vast stride forward during the 
past few years, abdominal surgery brings with it not only new 
methods of treating diseases in this region by the knife, but also 
has given us a method of curing peritonitis by the use of saline 
purgatives which is certainly of the greatest value in those sudden 
inflammatory conditions which occasionally spring into life after 
operations upon the abdominal area. It will be remembered that 
Mr. Lawson Tait has been the chief advocate of this treatment for 
several years, and that the wonderful results which he obtained, the 
reputation of the reporter, and the complete reversal of all our ideas 
concerning the treatment of the disease, have called forth not only 
an enormous number of trials of the method in this country, but 
have also brought forth two opposing factions in the profession. The 
first of these is chiefly composed of surgeons, the second of persons 
who in a long experience have reached good results by older meth- 
ods, and who are generally physicians. The first class dogmatically 
assert that the physician should turn over every case of peritonitis 
to the surgeon to be opened, searched, and purged ; the second class 
do not deny that saline purgatives do good in the hands of the sur- 



506 DISEASES. 

geon, but are more conservative in their opinions concerning the 
general measures in all cases of peritonitis. 

Again, it would seem impossible at the present time to assert that 
peritonitis may be either idiopathic or traumatic without bringing 
upon one's head a storm of criticism, for on the one side we have a 
number of physicians who believe the peritonitis may arise without 
any direct exciting cause, and on the other hand an equally large 
body of observers who assert that it is essentially a secondary in- 
flammation brought on by direct contiguity with an already inflamed 
tissue, or else that the inflammation is set up by the escape of foreign 
bodies into the peritoneal cavity, or by pathological changes occur- 
ring in organs normally situated in these regions, as for example, 
fibroid enlargements of the uterus with impaction in the pelvis, or 
pyosalpinx. 

As it is absolutely impossible for either side at present to prove 
that their opponents are wrong, and as both sides are not to be 
doubted in the integrity of their observations, the unbiassed judge can 
but come to the conclusion that, as yet, we have a right to believe 
that idiopathic peritonitis may exist. 

If those observers are correct who believe that no peritonitis arises, 
save as the result of some one of these conditions, then the attempt 
on the part of the physician to treat such a case is criminal negli- 
gence, and, as such, cannot be too severely condemned ; but too many 
cases of peritonitis are to-day walking examples of the value of the 
use of opium to permit of anyone asserting that this treatment is 
useless, or that the knife of the surgeon is to be used in every case ; 
yet some of the more positive members of the profession would have 
us believe that the abdomen should be opened solely for the purpose of 
making a diagnosis, and that this having been done, and no intestinal 
complications found, salines given. 

Whether the inflammation be idiopathic or not has little to do, 
however, with the methods which we are to resort to in the medical 
treatment of this condition. It cannot be gainsaid that the results 
obtained by surgeons in the use of saline purgatives have beeu start- 
lingly brilliant ; neither can anyone deny that their methods may 
sometimes be employed in medicine as well as in surgery ; but there 
are several points to be recalled by both parties which we think so 
seriously modify the views of each as, after all, to unite them in a 
bond of unanimity. No one denies that the surgeon does right 
when he uses salines to prevent peritonitis after an operation, but 
the knowledge of the condition of the patient after he has been oper- 
ated upon by the surgeon, and that possessed by the physician when 
called to see a case of peritonitis, are radically different, for the sur- 
geon has a right to believe that the intestinal canal is patulous and 
devoid of impactions and intussusceptions, while the latter knows 
not whether he has before him an inflammation of the peritoneum 
without intestinal involvement or inflammotion dependent upon 



PEKITONITIS, ACUTE. 507 

some abnormality in the prima via. As a consequence it is perfectly 
proper for surgeons to administer salines which, to use their own 
words, not only deplete the abdominal bloodvessels, but also by the 
increased peristaltic movements produced, prevent adhesions; while 
the physician in the case of peritonitis from perforation, impaction, 
or intussusception, may do the patient an immense amount of harm 
by such a procedure long before it is possible to decide what the cause 
of the trouble may be. It is evident, therefore, that the opium 
treatment must be adhered to, at least until the diagnosis is formed, 
unless at the very first sign of pain an exploratory incision is made 
instead of using those remedies generally employed in ordinary 
attacks of abdominal discomfort; aud it should not be forgotten that 
pain and tenderness with inflammation are the symptoms of perito- 
nitis, not only after section, but also of many other states in the 
ordinary individual. 

It is also evident that other conditions may exist which render 
the administration of purges unjustifiable, and in which the use ot 
the knife by the surgeon is not to be thought of. It is undeniable 
that the surgeon should be summoned the moment a suspicion of 
perforation arises, but in the case of a person in whom an enteritis 
has arisen locally by an old adhesion, increased peristaltic movement 
is equivalent to strapping the normal side of the chest in pleurisy 
with the object of giving the diseased side more exercise. 

Again, it is of the gravest importance that both the physician and 
surgeon should distinguish very clearly between an inflammation of. 
the peritoneum in a strong, healthy person, and in one who is in a 
condition of vital depression, or exhaustion from prolonged disease 
elsewhere. Depletion by means of purges is, of course, in the first 
class, as much indicated as the application of leeches or bleeding, but 
in the second class, quite as strongly contra-indicated. In the dyna- 
mic form of inflammation there is danger of adhesions being formed 
by reason of the fibrinous exudate thrown out; in the adynamic 
condition of inflammation there is already an enormous exudation of 
serum into the abdominal cavity which purges cannot remove until 
they have drained off a large amount of liquid from the blood. 

Again, there are some cases of peritonitis which are ushered in by 
an acute paroxysm of pain, but which do not continue during their 
whole course as dynamic cases, and in which depletion at first results 
in exhaustion later on. 

Until the profession have employed these two methods side by 
side, with an absolutely unbiassed opinion, for a long period of time, 
the only proper conclusion to be reached seems to us to be this, 
namely, that in acute peritonitis, suddenly lighted up in a surgical 
case, and which is recognized almost at the moment of its birth by 
the ever-watchful surgeon, who is on the lookout for it, and salines 
given ; whereas, in the case which the physician rarely sees till hours 



508 DISEASES. 

have elapsed, and in which grave doubt exists as to the cause of the 
trouble, opium and external methods of depletion must be resorted to. 



PERNICIOUS MALARIAL FEVER. 

This is one of the most acutely dangerous diseases known to man, 
if it be fully developed, and requires the greatest activity and skill 
on the part of the physician, who may be called upon to treat a large 
number of widely varied symptoms, all of a pressing nature, at one 
and the same time. The chief indication is for the use of quinine, in 
its most soluble forms, in solution aud in large doses which may 
amount to 60 or 100 grains, by the mouth, by the bowel, and hypo- 
dermically. (See Intermittent and Remittent Fevers.) 

The manner in which quinine acts in malarial poisoning is now 
generally conceded to depend upon its influence over the malarial 
germ of Laveran, which has been so well studied in America by 
Osier and Councilman. All the students of the subject have found 
that at least some of these bodies are made inactive aud disappear 
under the influeuce of the drug, and we have at last obtained a 
knowledge as to the manner in which quinine does good, which in its 
absence was a constant opprobrium to scieutific medicine. The 
saying that "As soon as the physiologist and pathologist tells the 
therapeutist what disease is, the latter will tell how his remedies do 
good/ 7 is very well exemplified by the use of quinine in malaria and 
the present well-founded scientific reasons for its employment. 



PLEURITIS, OR PLEURISY. 

Under the consideration of Peritonitis, the writer has already 
given so full an account of the treatment of acute inflammations 
affecting serous membranes or surfaces capable of throwing out 
a croupous or fibrinous exudate, that it seems scarcely necessary to 
repeat the directions here. It is to be remembered that an inflam- 
mation of the pleura is the same condition here as an inflammation any- 
where, and the treatment of this state in its early stages is identical, 
or, in other words, the use of venesection, or, better still, of tincture 
of veratrum viride or aconite to bleed the man into his own blood- 
vessels is to be resorted to. Along with these measures, counter- 
irritation in the way of blisters, or depletion by wet cups is in order ; 
but dry cups are never to be used in pleurisy over the diseased area, 
since they may produce ecchymosis of the pleura by their suction 
exercised through the intercostal spaces. Where dry cups are used 
they should be employed at some distant spot, as over the skin of 



PNEUMONIA. 509 

the back, where the tissues are too dense to permit of pleural involve- 
ment. In cases which are very sthenic it is best to give calomel for 
its aplastic effect, in order to prevent a fibrinous exudate. By this 
treatment nearly every case of pleuritis, if seen early enough, can be 
aborted. 

When the second stage of pleurisy, or the stage of effusion, is 
reached, other lines of treatment are needed. The cardiac sedatives 
have been stopped as soon as the quieting of the circulation, the 
lessening of pain, aud the absence of a friction-sound denote the 
passage of the case from one stage to the other. If the pulse becomes 
weak and the system is depressed, stimulants in the form of alcohol 
or digitalis are needed, and special care must be devoted to the con- 
dition of the exudation in the pleural space. If it is sufficiently 
large to cause dyspnoea on exertion, and is not readily removed by 
the administration of saline purges in concentrated form at the proper 
times, or if it is not taken up by the vessels after jalap or elaterium 
are used, then resort must be had to aspiration of the liquid by the 
proper apparatus. The physical signs at this time, it will be remem- 
bered, consist in flatness on percussion over the lower portions of the 
chest, which area of flatness generally varies with the changes in the 
position of the patient from the erect to the recumbent position, 
unless the effusion is sacculated, and the presence of blowing or 
bronchial breathing in the apex of the chest, where the lung is com- 
pressed upward by the fluid below it. During this stage of effusion 
blisters are often very useful in aiding the absorption of the liquid 
present. 

PLEURODYNIA. 

This condition being one of intercostal neuralgia, its treatment may 
be carried out according to directions given under the heading 
Neuralgia. 

PNEUMONIA. 

It is of the greatest importance that the physician should employ 
drugs in this disease at the proper stage, in the proper dose, and 
with definite ends in view. In the beginning of a pneumonia of the 
croupous type the state of the patient is utterly different, as a rule, 
from that of an individual attacked by the catarrhal form of this 
disease. The first generally attacks a person possessing sufficient 
vitality and force to cause him to suffer an acute inflammation of the 
tissues involved. In other words, the balance of health being de- 
stroyed systemic disturbance is far greater than if less vital force 
Avas misdirected from its proper functions, and as a consequence high 



510 DISEASES. 

fever with increased and excessive arterial tension rapidly asserts 
itself, the changes in the circulatory system being produced both 
directly by the diseased processes and indirectly by the heat of 
the body acting as a stimulant to all its functions. In catarrhal 
pneumonia the systemic changes are, as a rule, somewhat different, 
since the patient is more frequently already suffering from some pre- 
disposing disease, such as whooping-cough, bronchitis, measles, or 
similar affections. If the patient is still in good condition the fever 
and circulatory excitement may be equal to that occurring in the 
croupous form, but even if this be so, there will always be found 
symptoms of lowered vitality which must modify the treatment in the 
early stages of the attack. 

Under the head of Exhaustion and Depression the writer has already 
defined the differences between these states, and they have been indi- 
vidually described. It is important to emphasize that many diseases, 
taking pneumonia as an example, may be produced in two entirely 
different ways, or in two states of the system diametrically opposed 
to one another. On the one hand, we have a pneumonia attacking 
the lung of a strong and healthy individual who may be exposed to 
cold ; on the other, a pneumonia may attack an invalid recovering 
from typhoid fever or other exhausting disease, such as any one of 
the exanthems or phthisis. The question of the presence of pneu- 
monia is of course to be decided, but the state of the system is to be 
the guide in the treatment. In the perfectly healthy man, who has 
pneumonia, exposure to cold upsets the normal balance and the full 
force of his system runs riot and must be reduced to its proper level. 
In the w r eakly individual the curve of health has fallen below the 
normal line and must be raised until it is regained. In a sthenic 
pneumonia there are three stages of treatment : (1) The depressant 
or abortive stage, and if this fails, (2) the supportive, followed finally 
by (3) measures for the relief of the recovering lung in convales- 
cence. In asthenic adynamic pneumonia we must omit all depressant 
treatment and resort at once to the second or supportive measures. 
The remarks which immediately follow, it is to be remembered, 
have only to do with the so-called first stage in sthenic cases. 

If the patient shows symptoms of weakness, as evidenced by the 
pulse and other signs of disease, the treatment is to be considered 
under the second stage. 

It should be remembered, however, that the mere fact that either 
stage of the disease is in existence should only lead to a most thor- 
ough study of the indications present. 

Primary Stage. — The primary stage of a pneumonia consists in an 
increase in the calibre of a larger or smaller number of the blood- 
vessels so that congestion occurs, the blood stagnates and an exuda- 
tion ensues. We have, therefore, a state of the vascular system in 
which all the bloodvessels of the body are tense, except those which 
are relaxed by the inflammation in the lung, and the blood flowing 



PNEUMONIA. 511 

in the direction of least resistance still further stagnates in and en- 
gorges the diseased area. All this occurs in the first stage, aud it is 
the object of the physician so to relieve the over-pressure in the 
general system that the blood will leave the lung in order to obey 
the law of resistance which has originally caused it to accumulate in 
this locality. 

In those instances where the diseased process goes on still further 
into what is known as the second stage, or that of consolidation, the 
indications are at once reversed and the change from the proper plan 
of treatment for the first stage to that necessary for the second may 
be required very promptly. The stagnation of the blood, combined 
with the pressure exerted by the rapidly forming exudate, not only 
narrows the patulous vessels by its pressure but so prevents the ex- 
pansile movements of the lung that proper pulmonary circulation 
cannot occur. As a consequence the right side of the heart is dis- 
tended at first and exhausted finally by the resistance offered to the 
blood-stream which it is forced to propel, and is simultaneously fed 
by blood which, by reason of the deficient respiration of the patient, 
is loaded with an excess of carbonic acid. Under these conditions 
the circulation must be so strengthened as to be able to force the issue 
and support the heart in its effort to overcome the obstruction. 

The methods which may be resorted to during the primary stage 
are very numerous, but there are only two which can be recognized 
as of great value, while the other procedures are but subordinate 
measures. These two measures are bleeding and the use of such 
drugs as our clinical and physiological knowledge tell us are proper. 
The discussion of bleeding as a therapeutic measure will be found 
on page 326, and it will readily be seen that the abstraction of blood 
from the entire system will rapidly relieve the diseased lung. The 
second, and by far the best method, is by the use of veratrum viride, 
aconite, and antimony, and perhaps several other drugs of a similar 
class. 

In adults veratrum viride will be found far more useful than 
aconite, while in most instances the reverse will hold true in children, 
in whom aconite always exercises a far more wholesome influence 
than any other drug of this class. Supposing that the disease be in 
the adult, let us for the moment consider why veratrum viride in 
this first stage is so useful a medicament. It will be remembered 
that the two alkaloids, jervine and veratroidine, possess different 
influences, and that between them they fulfil every object which is 
sought after. According to the experiments of Wood, jervine is a 
most powerful vaso-motor depressant, relaxing to a remarkable degree 
the walls of the bloodvessels everywhere, and not only does it do 
this, but, at the same time, so quiets the heart by an action over its 
muscle or ganglia as to reduce its force, thus preventing engorgement 
of the lung, while veratroidine by stimulating the inhibitory nerves 



512 DISEASES. 

of the heart also slows its beat, fills the ventricles, and allays excite- 
ment. 

Further recollection of physiological facts shows ns that the blood- 
vessels of the abdomen are capable of holding all the blood in the 
body, and into these will flow the major portion of the fluid which 
is filling the pulmonary vessels, at once lowering blood-pressure very 
greatly everywhere, so that the lung is starved of blood without 
dangerous engorgement taking place in the abdomen. 

The manner of using veratrum viride is a good example of the 
necessity of careful physical diagnosis and a clear idea of what one 
is about to do. Used at the proper time and in the proper amount 
it is most useful, but when abused it is dangerous or disappointing, 
according to the carelessness of the physician. The following case 
is in point : A. E., aged twenty-five, brakemau, always strong and 
well, was much exposed to wind and snow after having been thrown 
into a profuse sweat by coupling a large number of cars. He had a 
severe chill that evening, ushered in by a cough and followed by 
fever and a sense of oppression with somewhat hurried breathing 
and pain in the side. At the time of admission, three hours after 
the chill, he had a temperature of 103° F., the eyes were bright, the 
expression of the face slightly anxious. Physical examination showed 
exaggerated breathing over the entire right side, while at the base of 
the left lung posteriorly there was marked bronchial breathing and 
dulness on percussion. Fine rales could now and then be heard, but 
were not constant. The pulse was full and bounding. This man 
was at once given 3 drops of the tincture of veratrum viride every 
two hours until such a time as he complained of faint nausea, and 
his pulse was found to be no longer rapid and bounding, but soft 
and slow, while the skin was moist and relaxed. The sense of oppres- 
sion disappeared, the expression of anxiety passed away, no pain was 
felt in the chest, and the attack was aborted. 

The employment of veratrum viride in this instance took place 
at a period in which it was possible to quiet the inflammation by 
u bleeding the man into his own vessels,'' and if it had been used 
later would have done more harm than good, as we have already 
shown when discussing the state of the inflamed part at the com- 
mencement of the second stage, and to which we shall refer later on 
when speaking of the treatment of that stage. 

The advantages of veratrum viride are its completeness and rapid- 
ity of action, the fact that it preserves in healthy bloodvessels the 
blood which may be needed in the crisis if the disease is not aborted, 
and lastly, its safety 1 is a point largely in its favor. 

The use of aconite in pneumonia is of particular value in children, 

1 Both veratroidine and a resin contained in veratrum viride are powerful emetics, 
so that upon the ingestion of a poisonous dose of the drug so much is generally vomited 
that recovery spontaneously occurs. The symptoms produced are said to yield to treat- 
ment with remarkable readiness. 



PNEUMONIA. 513 

in whom the emetic effects of veratrum viride often prevent its being 
pushed to a sufficient degree to permit of an effect on the circulation. 
The indications for its employment are identical with those already 
named when speaking of the use of veratrum viride, and the only 
question which arises is as to whether its physiological action and 
clinical record justify its use. In reply to such a query the answer 
may be that it does act favorably in pneumonia, but that it is not as 
thorough as other drugs. The studies of Ringer, Achscharumow, 
Boehm, and Wartmann all prove that the drug is a distinct cardiac 
depressant, but there is no reliable evidence to prove that it exerts 
any vaso-motor influence, the fall of arterial pressure being produced 
only by the decreased action of the heart. On the other hand, there 
can be little doubt that clinically the arterial pressure seems decreased 
by the drug. It at once becomes evident, however, that while its 
influence is for good in pneumonia, it does not possess the scope of 
action which makes it desirable in every case, yet its powers of pro- 
ducing nervous quiet, allaying vomiting, or meeting some idiosyn- 
crasy make it a drug always to be thought of in this disease. An- 
timony, although at one time used very largely in the treatment of 
pneumonia, has very properly ceased to be so commonly employed, 
chiefly for the reasons that it is a poison capable of producing decided 
morbid changes in the tissues, seeming to deprive them of their vital 
power for long periods of time, and that it often induces nausea of 
a distressing type, or even vomiting, before it can be pushed to a 
sufficient degree to cause the desired circulatory depression. Next 
to veratrum viride it holds a more useful position in extremely 
sthenic cases than any other drug, and may be used if the patient be 
unusually robust. Unlike aconite, which expends its chief action on 
the heart, this drug not only quiets and slows the pulse by an action 
exerted directly upon the heart muscle and its motor ganglia, but in 
addition markedly affects the vaso-motor system, thereby aiding in 
causing the desired fall of arterial pressure. The proper dose of 
tartar emetic is ^ grain repeated every two hours till the skin shows 
moisture, nausea asserts itself, or the pulse shows sufficient relax- 
ation. 

Gelsemium has been highly recommended by Bartholow in the 
treatment of the early stages of pneumonia, but is certainly of very 
inferior influence, and is at the same time a dangerous drug. 
The use of chloral has been attempted, but its other powers so domi- 
nate its action on the circulation as to make it useless for the purpose 
before us. There can be little doubt of the value of pilocarpine in 
the very earliest stages of the malady. Given in full dose hypo- 
dermically it will produce so profuse a sweat and so great a lower- 
ing of arterial pressure as materially to relieve the congested lung. 
Its value, however, depends upon its very early employment, and it 
should not be used if any tendency to true consolidation has already 
asserted itself. 



514 DISEASES.. 

The application of cold to the chest in the early stages of pneu- 
monia has been resorted to very largely in Germany by Liebermeister, 
Niemeyer, and others. It is said that the dyspnoea is decreased at 
once, and the pain lessened. Bartol and Ziemssen speak of it highly 
in the croupous pneumonia of children, but the writer would fear to 
use it in any such instance, unless the child was above puberty and 
very strong. 

If cold is used it should be employed as an ice-poultice made ot 
cracked ice and sawdust, mixed and sewed up tight in an oil-silk 
bag in such a way as to prevent the bed and clothes from becoming 
wet. At this period, too, very distinct effects can be exercised over 
the bloodvessels of the lung by irritation of the skin, which results 
in the reflex wave already spoken of under Counter-irritation 

The last and most active means of producing this counter-irritation 
is by the use of the dry cup. The wet cup may be used to deplete 
or bleed the patient at the same time that it acts as a counter-irritant, 
but in many instances the dry cup will suffice. If the counter-irri- 
tation is to be thorough the cups should be applied to the number of 
five or six, scattered over the area involved and a little to the sides 
of the diseased patch. 

Mustard may be employed and a turpentine stupe (see Turpentine) 
or cayenne pepper be used as counter-irritants. The latter is at once 
one of the most efficient and least dangerous irritants, as it produces 
much reddening and irritation, but does not destroy or burn the 
skin. 

The treatment of the second stage of pneumonia, when of a sthenic 
type, is much more difficult and hazardous than the treatment of the 
first stage. The question as to the line separating the first from the 
second stage must be clearly answered in the physician's mind, and 
distinct indications must exist for the employment of measures suited 
to the disease at this period of its development. The physical signs 
in the chest are only of value as evidencing the progress of the local 
diseased process, and only indirectly indicate the use of a given line 
of treatment, while the state of the pulse, the color of the skin, more 
particularly of the face, the duskiness of the nails, along with the 
rhythm of the respirations, tell the physician how the patient is 
standing the strain. This is not the place to discuss the possible 
causes of death under these conditions, but to indicate clearly what 
is to be done (when the flagging to and fro pulse indicates arterial 
starvation, while the dusky skin and pulsating jugulars show venous 
engorgement and distention of the right side of the heart. The 
employment of digitalis is here of the greatest service. It should 
be given in 5 drop doses of the tincture every four hours, and 
be accompanied by 2V of a grain of strychnine three times a day, 
or oftener, as the case may require. If the digitalis is carelessly 
given, and its effects are not watched, it may be found to produce so 
rapid and irregular a pulse at the wrist as to give one the impression 



PNEUMONIA. 515 

that the heart needs still further doses of the drug, but if the ear be 
placed over the praecordium under such circumstances the violent 
apex beat, diffused thrill, and accentuated heart sounds, will show 
that this viscus is over-stimulated, and that the drug should be with- 
drawn until some hours have elapsed, and its need evidenced by a 
condition of real cardiac enfeeblement following a stage of marked 
improvement due to the temporary withdrawal of the drug. 

Haviug recommended these drugs in these states, let us study why 
they do good and the reasons for their use. According to a mass of 
experimental evidence, which by its very volume is incontestable, 
digitalis acts upon the heart muscle as a most powerful stimulant, 
increasing the force of contraction in the cardiac walls and driving 
the contents of the ventricles out into the pulmonary artery and 
aorta with an unmistakable increase in arterial tension. The ex- 
periments of Boehm showed that the heart does actually more work 
under digitalis, and these studies have been confirmed by Williams. 
Francois Frank agrees with Williams in the belief that this in- 
creased force is due to improved tone of the cardiac muscle. These 
facts indicate the raison d'etre of the use of digitalis in the second 
stage of pneumonia, since it enables the right side of the heart to 
send the venous blood to the general arterial system and prevents 
the over distention of the right ventricle. When we remember, on 
the one hand, that all muscular fibres rapidly become paralyzed by 
over-distention, and, on the other, that digitalis produces a systolic 
contraction of extreme completeness, we can readily see how, by the 
entire emptying of the ventricle at each contraction, distention is 
impossible. It seems probable also that the pneumogastric nerves 
are the trophic nerves of the heart, and that in consequence its 
nourishment is improved by their stimulation by the digitalis. (See 
articles on Heart Disease and Digitalis.) 

There are other reasons, however, why digitalis should be used at this 
time, which are only second to those just named. The heart-beat under 
its influence is greatly slowed, and by means of this slowing becomes a 
cool-headed man instead of a flurried, nervous, irritable invalid. By 
its very slowing it finds time to carry out all its functions regularly, 
and with " all its might," it does not exhaust itself by fruitless effort, 
and accomplishes far more than when it is irregular, and uncertain 
as to whether it is to contract or expand. That digitalis slows the 
pulse by a stimulation of the pneumogastric nerves has been proved 
beyond all doubt, and the remembrance of the fact that these nerves 
are respiratory in function as well as cardiac, clearly indicates the 
value of this influence. They supply motor fibres to the muscular 
coats of the entire bronchial system, the tonicity of which is most 
important for the well-being of the lung, since by this means the 
quantity of air admitted to the vesicles is equalized and the excessive 
use of the healthy vesicles prevented. Longet asserts that the " lung 
tonus" during increased tension (which is present during pneu- 



516 DISEASES. 

nionia) depends solely upon these muscles and their proper nerve 
supply. These assertions are once more supported by the experi- 
ments of Graham Brown and Roy, which prove that the vagal 
filaments are to the lung and its air streams what the vaso- motor 
nerves are to the circulatory system, dilating or contracting the 
bronchial tubes as may be necessary. Digitalis by stimulating them 
increases their tone and supports them when strained. The assertions 
of Schiff, that the vagus is the vaso-motor nerve of the lungs is only 
partly true and is so doubtful as to prevent any value being derived 
from this fact, so far as the blood supply is concerned. Another 
way in which digitalis does good is often overlooked. The respir- 
atory centre is governed solely by the condition of the blood. If this 
fluid be overladen with carbon dioxide it sends out more impulses 
and rids itself of the gas by the increased respiratory effort ; or, if an 
excess of oxygen is present it sends out fewer impulses until the 
normal balance is restored. It is also to be remembered that Marck- 
wald has proved that the pneumogastric nerves are the regulators 
of the impulses sent out by the respiratory centre, so that a perfect 
rhythm is obtained. The asphyxia due to a partial laming of a 
lung by pneumonia increases the number of respiratory efforts, and 
in consequence the labor of the vagus is increased. Very commonly 
we see cases of pneumonia in which the breathing is hobbling, with 
a distinctly altered rhythm, now fast, now slow, now full, now deep, 
in which the breathing becomes regular and quiet after digitalis is 
used in the proper amount, a result often accorded to the cardiac 
influence of the drug, but largely due to its effects on the respiratory 
portion of the vagus nerves. The same advantages are gained by a 
regulated respiratory effort on the part of the lungs, as are obtained 
in the case of the steadied heart. 

In those cases where digitalis is pushed too far these favorable 
effects are replaced by the most unfavorable conditions as has already 
been described in the discussion of this drug in heart disease. Here 
as elsewhere over-stimulation is as bad as lack of proper tone. 

Strychnine is used to carry out an object supplementary to that 
of digitalis, for it has been proved to be one of the most reliable 
and powerful stimulants that w T e have upon the respiratory centres, 
which are apt to be exhausted by rapid breathing. It also prevents 
general nervous depression and aids in the maintenance of a circu- 
latory balance by its effects on the vaso-motor system and heart 
muscle. 

The employment of alcohol in the second stage of pneumonia is 
based upon the same principle as is the use of digitalis. It is inferior 
to the latter drug because it stimulates the heart without giving it 
any more strength. That is to say it stimulates and causes the ex- 
penditure of all the power the heart is capable of but does not replace 
the power so expended. Further than this it possesses the disadvan- 
tage of acting a comparatively short time, dose for dose, and tending 



PNEUMONIA. 517 

to cause cerebral excitement or heaviness if it is pushed to the point 
of stimulation required by the heart. In persons addicted to its ex- 
cessive use it either fails to act, produces effects the contrary to those 
desired, or actually aids the diseased process. The danger of form- 
ing the alcoholic habit is also to be remembered. 

Having detailed this treatment of the second stage, that for the 
third stage is to be considered. For the thorough understanding of 
this we should remember that it consists in the breaking down or 
resolution of the exudations and in their .absorption and expulsion 
from the chest. 

At this time the entire diseased area is crowded with secretions 
which have been formed, dead epithelial cells and all the morbid sub- 
stances which have accumulated. The local surfaces are de- 
pressed by the reaction following upon the excitement of inflamma- 
tion, and their tone is below par. The object of the physician must 
be to stimulate these areas so that they may throw off the old and 
take on a new functional activity, and for this purpose remedies are 
to be used which will soften deposits and stimulate depressed vesicles 
and bronchial tubes. 

By far the most valuable class of drugs to be here employed are 
those which will increase the secretions from mucous membranes 
without acting as cardiac depressants. Antimony is a remarkable 
drug for the production of a large secretion, but is often too depress- 
ing to the heart after its prolonged strain. Under the consideration 
of bronchitis the action of these drugs will be found more thoroughly 
explained, but it will suffice to point out, at this time, the method 
of their administration. 

First and foremost stands the chloride of ammonium, a drug 
whose elimination takes place chiefly through the lungs, and acts most 
happily in aiding in the loosening of the cough and secretions. Its 
only disadvantage is its salty taste, which in many cases renders it 
disagreeable to the patient, while its irritant properties may disorder 
the action of the stomach, although if this organ is depressed and 
atonic this drug often improves its condition. The drug may be 
given in compressed pills, or, what is far better, in such a mixture as 
here follows : 

R. — Ammon. chloridi ^ij. 

Ext. glycyrrhiz. . . . . . . gij. 

Aq. dest . q. s. f^iij. 

M. — S. Teaspoonful in water every four hours during the day. 

If the cough be in excess of the expectoration, that is, if the cough 
often fails to bring up phlegm and is due to tickling or irritation, it 
may be relieved by the addition of a little morphine to the mixture, 
as follows : 



518 DISEASES. 

R. — Morph. sulph ; gr. jorij. 

Ammon. chloridi . . . . . . ^ij. 

Ext. glycyrrhiz ^5 iij. 

Aq. dest f 25 vj. 

M. — S. Dessertspoonful every four hours. 

If more morphine than this be used it will tend to stop secretion. 

When the chloride of ammonium fails to act favorably, the car- 
bonate may be called into use for its local and circulatory action, 
and, in addition, the bromide of ammonium may be employed to 
allay the cough if morphine cannot be used. The following pre- 
scription is valuable : 



fy. — Ammon. chlorid. 
Ammon. bromid. 
Ammon. carbonat. 
Ext. glycyrrhiz. 
Aq. dest. 
M. — S. Dessertspoonful every four hours. 



• 3J- 
s. ad f ^ vj. 



, For other remedies for this stage, see page 364 (Bronchitis). 

In the beginning of pneumonia a blister should not be applied 
immediately over the congestion, but a little to one side, as it may 
increase the congestion if placed over the diseased area. When reso- 
lution begins the blister may be placed over the exact spot to aid 
reparative changes. 

So far the treatment given has dealt with a routine case ; let us 
suppose that things run less smoothly and complications arise. It 
will be impossible, in a book on therapeutics, to explain the causes 
of all the dangers which may present themselves ; one of the most 
common of these is an increase in the area of the consolidation or its 
development elsewhere, or, in other words, a second attack super- 
imposed on the first. The treatment of this most dangerous state of 
affairs requires the greatest care, skill, and intelligence, and consists 
primarily, not in the use of cardiac sedatives, but in the administra- 
tion of digitalis and stimulants, in order to drive out the blood from 
the new congestion, or to enable the system to bear the strain. A 
blister or dry or wet cup applied thoroughly a little to one side of 
the spot involved, may aid in its removal, the application of mustard 
plasters to the feet is indicated, or a turpentine stupe may be applied 
to the entire chest. The use of expectorants stimulating to the 
lungs, if they are being employed, is to be stopped at once, and 
nourishment given in small amounts, carefully prepared, and fre- 
quently administered. It is to be remembered, however, that above 
all things the physician must use his judgment, and if he finds that 
sufficient strength yet remains to his patient for the second attack to 
partake of a dynamic or sthenic character similar to that of the first 
he must use bleeding, leeching, cupping, or cardiac sedatives. 

If the consolidation be very widespread in auy case the entire 
heart becomes strained by the venous congestion and arterial tension, 



PRURITUS. 519 

due to partial asphyxia, while there is also danger of death from 
lack of oxidizing space for the blood. No better treatment exists 
under these circumstances than the inhalation of oxygen, either 
almost pure or mixed with air. By this means even a small patch of 
lung offers sufficient oxygen to the blood to cause its complete oxida- 
tion. This gas may be obtained in small cylinders, which, by compres- 
sion of the gas, will hold forty gallons, at several large establishments, 
notably at the offices of the S. S. White Dental Company, which 
has agencies in all the large cities of the United States, or it may be 
made by the physician himself in the following manner : Take 4 
ounces of chlorate of potassium, which must not contain a single 
chip or piece of organic matter, and add to it an equal quantity of 
peroxide of manganese. These should be placed in a retort or strong 
flask, and an alcohol lamp placed under it. The gas, as it is gener- 
ated, escapes through a tube, which should pass into a large jar of 
water so that the gas, as it bubbles up, may become cooled and puri- 
fied ; a second tube may now lead the gas to an inhaler over the 
patient's mouth. It should be remembered, however, that chlorate 
of potassium may explode if contaminated by the smallest piece ot 
organic matter. 

The period in the treatment of pneumonia when simple poultices 
do the greatest service, and the only time when they are to be em- 
ployed for valid reasons, is during the second and third stages of the 
disease, when clinical experience shows that they are of value in 
aiding in the production of resolution and in loosening the cough. 
How they act, except by increasing the warmth and moisture of the 
parts, we do not know, unless by the production of some reflex 
influence excited upon the lungs from the skin by means of the 
nerves. Unless the attendant is unusually intelligent and well 
trained, the common poultice does more harm than good, because it 
is allowed to get cold, or the patient is chilled when it is changed. 
The proper application is the cotton and oiled-silk jacket, particularly 
in young and restless children. 

The remarks which have just been made deal entirely with simple 
poultices, and not with those possessing other agents in their mass, 
such as those agents belonging to the counter-irritant group of drugs. 
By far the most commonly used substance under these circumstances 
is mustard, and its addition to the mass at once allows this method 
of treatment to be employed in the first as well as in the later stages. 



PRURITUS. 

Itching of the skin or mucous membranes about the openings of 
the body is a very common state, and while it may be dependent 
upon local causes, such as lice or fleas, it more commonly depends 



520 DISEASES. 

upon some systemic state, as debility, diabetes, albuminuria, or other 
similar causes. The treatment, therefore, consists, first, in the 
removal of the cause, and, next, in the local treatment of the condition. 
There is generally no redness, except from scratching. 

Internally, arsenic, quinine, bitter tonics, cod-liver oil, alkaline 
diuretics, or mineral waters, are useful in debilitated cases, and an 
avoidance of condiments, such as mustard or pepper, is needful if the 
disease affects the mouth of the urethra or vagina. 

The local treatment of pruritus consists in the use of lotions, 
salves, or ointments made up of various constituents, a number of 
which are capable of acting as local anaesthetics. Very often bathing 
the the parts with 1 drachm of bicarbonate of sodium or of borax to a 
pint of cold water gives relief temporarily, and the following formula 
will be of service : 

1£. — Acid, carbolic. f^j to f^ij. 

Aq. dest. q. s. 6j. 

M. — S. Apply as a lotion several times a dav. 

Or, 

B=. — Liquor carbonis detergensi . . . . f^ij. 

Aquae q. s. Oj. 

M. — S. Apply as a lotion. 

or an ointment made up as follows is serviceable : 

R. — Acid, carbolic. gtt. v to xx. 

Adeps benzoinatis J|j. 

Ung. petrolei . . . . . . • %]• 

M. — S. Apply as an ointment. 

In other cases, 10 to 20 minims of chloroform may be used in 
place of the carbolic acid. 

Cocaine may be painted over the parts, but it should rarely be 
used in ointment, as fats prevent its acting effectively. It should 
also be remembered that the anal and vaginal mucous membranes 
are. so thick that strong solutions are necessary to produce anaesthesia 
and that the effects of cocaine are only temporary. Where the 
itching is very obstinate the parts may be painted with a solution of 
nitrate of silver of the strength of 20 grains to the ounce of water, 
cocaine having been previously applied to relieve the pain of the 
application. 



PUERPERAL DISEASES. 

The diseases of the puerperium may be divided into two broad 
classes — infectious and non-infectious. The first class should be 
further sub-divided into (1) those infectious diseases in which the 
point of infection has been somewhere along the parturient tract, and 
(2) those in which the infecting poison has entered the body by some 

1 For method of preparing this liquor, see page 407. 



PUERPERAL DISEASES. 521 

other channel. Under sub-heading 1 come all those diseased condi- 
tions, grouped together in the very inadequate generic terms "puer- 
peral fever/' "puerperal septicaemia," " puerperal infection/' and the 
like, none of which truly expresses the condition. If it is necessary in 
medical nomenclature to have a single term which shall denote infec- 
tion of the genitalia after delivery, a word should be coined strictly 
limited in sense to mean the pathological conditions which result 
from the activity of pathogenic microbes along the whole genital 
tract. This classification is necessary for a clear and systematic de- 
scription of the treatment of diseases in the puerperal state. 

The treatment of infection along the genital tract after labor. By 
far the most common form of infection along the genital tract after 
labor, is the absorption of ptomaines from the infection and decompo- 
sition of membranes, fragments of placenta or blood within the uterus. 
This condition will be found in more than 75 per cent, of all cases 
in which infection occurs at all. Therefore, in any case, after labor, 
in which there is fever that can not be explained by some evident 
cause independent of the genitalia, it is safe to assume ptomaine 
poisoning and to act accordingly. The indications are plain : to 
destroy the microbes and thus at once stop the manufacture of their 
poisonous products, and, if necessary, to remove their habitat. 

The writer's routine application of this principle in practice is as 
follows : If the temperature, after delivery remains over 100°, for 
twenty-four hours without evident cause, independent of the geni- 
talia, he washes out the uterine cavity with at least 1 quart either of 
bichloride of mercury solution, or a 2 per cent, solution of 1 : 2000 
creolin. The former is more convenient in private practice because 
the tablets of corrosive sublimate can be easily carried about in one's 
instrument bag. To insure the entrance of the antiseptic fluid to the 
fundus and its free exit from the cervical canal, an intra-uterine catheter 
is desirable. Of all those upon the market, the best is that manu- 
factured by Lentz, an instrument maker of Philadelphia. If, how- 
ever, the cervical canal is patulous, as it usually is after labor, a hard 
rubber catheter attached to a Davidson's or fountain syringe, answers 
the purpose perfectly. 

In the majority of cases this treatment will bring the tempera- 
ture down to normal within twenty-four hours. If fever does 
not disappear within this time, or even perhaps rises higher, the 
second indication must be met. The infected albuminous substance 
within the uterine cavity must be removed in order to deprive the 
microorganisms of their feeding-ground. This is best accomplished 
by the use of the curette and the placental forceps, care being taken 
in the employment of the former instrument to guard the uterine 
wall itself from the slightest injury, for not only can the uterine 
muscle be perforated by a curette in clumsy hands, but slight wounds 
of the uterine substance with this instrument may be enough to 



522 DISEASES. 

inoculate the general system with the germs whose activity had been 
confined before to the uterine cavity. 

The writer's manner of employing this plan of treatment after 
labor is as follows : 

The anterior lip of the cervix is seized with a double tenaculum 
and pulled gently downward ; a cleansing uterine douche is then 
given in order to disinfect the field of operation ; next the curette is 
inserted to the fundus, and the whole interior of the uterus is care- 
fully gone over with the instrument. First the fundus and then 
each of the four sides ; then the curette is turned with the scraping 
surface upward and withdrawn from the cervical canal, a finger in 
the vagina meeting its tip as it emerges in order to help extract any 
substance which may be caught by and entangled in it. 

Next the placental forceps is inserted and an effort made to grasp 
any material lying loose within the cavity or still attached to the 
uterine walls. It is usually best to repeat each of these manoeuvres 
several times until nothing more can be brought away except a little 
clear blood. 

Then the uterine cavity is again thoroughly washed out. The 
writer has many temperature charts in his possession which show 
the success of this treatment, when simple uterine irrigation has 
failed. Occasionally it is necessary to repeat the irrigation, and even 
the curettement, for several successive days. If, as rarely happens, 
this treatment should prove unsuccessful and the temperature should 
remain elevated in spite of irrigation and the use of the curette and 
placental forceps, one must assume either that general systemic 
infection has occurred, or, at least, that an inflammatory action has 
begun in the uterine walls or within the tract of the tubes. One 
of the earliest, surest signs of systemic invasion is the appearance of 
peritonitis. 

In such a case the only available treatment is to support the body- 
cells in the combat which they must wage with the invading micro- 
organisms. This is best accomplished by the administration of as 
large a quantity of nutriment as the patient can stand without re- 
bellion of the stomach or bowels, and the exhibition of a large 
quantity of alcoholic stimulant. Cases of this sort not infrequently 
require more than a pint of whiskey or brandy in the twenty-four 
hours. Occasionally measures will be required to reduce an ex- 
aggerated elevation of the temperature, but this is best abstained 
from as long as possible, for antipyretic treatment is usually depress- 
ing and ill-suited to the patient's adynamic condition. 

With this plan of treatment, about three-quarters of the cases of 
general septic infection, after labor will recover. There may be some 
in which metastasis occurs so early to important organs as to render all 
treatment of no avail. There will be others in which the peritoneum 
is early infected, and in which the septic peritonitis develops rapidly 
and to an extensive degree. It is in such cases that laparotomy and 



PUERPERAL DISEASES. 523 

evacuation of the septic matter, usually pus, within the peritoneum 
will occasionally save life. The physician must guard himself, how- 
ever, from the disposition which is prevalent at this day, to operate 
too early and unnecessarily. After operation, drainage of the perito- 
neal cavity is an essential feature of the treatment, even although the 
evidence of suppuration within the cavity is slight. The writer has 
in mind a case in which an operation was performed ten days post- 
partum, for septic peritonitis ; a very small quantity of puru- 
lent lymph was found upon one ovary, which was greatly enlarged 
and contained a small quantity of sero-pus. The ovary was removed 
and the abdomen closed without drainage, as there was no other 
evidence of suppuration within it. Thirty-six hours later the patient 
died and the peritoneal cavity was found filled with pus which had 
accumulated in that short space of time. In the early stages of the 
peritoneal infection, if the subject is vigorous, not exhausted by a pro- 
longed labor or other depressing causes, the administration of saline 
purgatives in concentrated solution will often effect brilliant results. 

The writer's system is to give a dessertspoonful of the concentrated 
solution of Epsom salts every fifteen minutes until free evacuation of 
the bowels is secured. He has seen the temperature reduced by this 
plan of treatment from 104° to normal, in the course of twelve hours, 
and with the reduction of temperature all the symptoms of peritonitis, 
which were well marked, entirely disappeared. In the treatment of 
microbic activity along the parturient tract, after labor, it should 
never be forgotten that the point by which the microbes invade the 
system, may be anywhere from the fundus of the uterus to the partu- 
rient outlet, therefore the practitioner should never negleot to examine 
carefully all the lower parturient tract, in order to detect, if pos- 
sible an ulcerated surface covered by diphtheritic membrane, which if 
overlooked might be the entrance-point for a fatal infection. These 
unhealthy surfaces are best detected by the use of a cylindrical spec- 
ulum of clouded glass introduced so that the cervix appears within 
its inner end and then withdrawn, so that the vaginal mucous mem- 
brane as it prolapses into the end of the speculum may be examined, 
and treated if necessary throughout its whole extent. If an unhealthy, 
ulcerated wound is thus discovered, the writer's practice is to apply 
to it a solution of nitrate of silver 40 or 60 grains to the ounce. In the 
vast majority of cases this application will promote an exfoliation of 
the unhealthy membrane, and the appearance of healthy granulation 
tissue within a few days. 

It may, in some cases, be necessary to employ a stronger applica- 
tion, as the solution of chloride of zinc, but the writer has not been 
driven to its use. The most common point of infection outside the 
parturient tract after labor is some portion of the urinary apparatus, 
almost invariably the bladder. The process of parturition necessarily 
diminishes the vitality of the vesical mucous membrane cells by the 
pressure and stretching to which they are subjected. After labor, 



524 DISEASES. 

therefore, they are not in a condition to resist the attacks of micro- 
organisms, should these in any way gain access to the vesical cavity. 
Most commonly microbes are introduced into the bladder by a cath- 
eter. This, however, is not necessary, as it has been plainly demon- 
strated that they can wander from the vaginal canal through the 
urethra into the bladder without the intervention of an instrument 
which directly carries them into the vesical cavity and deposits them 
in that situation. Once arrived within the bladder the microbes 
attack the depressed bladder cells, and very often gain a lodgement 
in the vesical mucous membrane. This is manifested by the usual 
symptoms of septic cystitis, fever, pus in the urine, pain on pressure 
over the hypogastrium, and pain and difficulty in micturitiou. The 
duration of these symptoms is, as a rule, not very long. The fever 
subsides, and the symptoms of cystitis disappear. After an interval 
of some days, however, there is again a sharp outbreak of fever, with 
pain in the region of the kidneys, and the re-appearance of pus, or at 
least of numerous microbes in the urine. This indicates a septic infec- 
tion of the pelves of the kidneys after the microorganisms have 
migrated along the ureters. During their course their presence has 
not been manifested by any symptoms. In the majority of cases 
even the symptoms of pyelitis will disappear after a time, and the 
patient will make a good recovery ; but in a certain proportion there 
is a systemic infection by the direct passage of microbes or their 
products from the kidneys into the blood. There may be an exten- 
sive suppuration of the kidneys and surrounding tissues, with fatal 
result, or, as the writer has seen in several cases, the symptoms of 
general systemic infection become so grave as for a long time to 
threaten the patient's life. In the worst cases of bladder infection 
the mucous lining sloughs, peritonitis develops, and the patient dies 
before the disease has time to spread to the kidneys. 

The practitioner, bearing in mind the serious consequences of 
septic cystitis after labor, should always be on the watch for it, and 
should adopt, immediately upon its discovery, an energetic treat- 
ment. A thorough disinfection of the bladder will remove all 
present symptoms, and prevent the occurrence of grave and possibly 
fatal after-complications. To accomplish this purpose the writer 
employs one-half of one per cent, solution of creoliu. One injec- 
tion of a quart of this solution through a two-way catheter is usually 
sufficient. Occasionally it is necessary to repeat it, or to follow it by 
several injections of boric-acid solution. In susceptible individuals 
creolin causes too much pain to be employed. A 1 to 8000 bichlo- 
ride of mercury solution may be substituted for it, or, in mild cases, 
a solution of boric acid alone will be sufficient. 

If, in spite of all precautions, infection of the kidneys should 
ensue, a vigorously, stimulating and supporting plan of treatment 
affords the only hope of success. If extensive suppuration occurs in 
the kidneys, all treatment will, of course, be useless. 



NON-INFECTIOUS DISEASES OF THE PUERPERIUM. 525 

Perhaps the most uncommon point of septic infection after labor is 
the rectum. The writer has, however, seeu one fatal case of this sort 
from the use, no doubt, of a dirty syringe nozzle in the hands of a 
careless nurse. It would be difficult, or perhaps impossible, to diag- 
nose such a case until after death, and, therefore, treatment directed 
toward this form of infection will usually not be adopted. 

Next in frequency to the parturient tract and the urinary system 
as a region of infection after labor come the breasts. Infection of 
the nipples, and a consequent mammary inflammation, or suppura- 
tion, is one of the most troublesome minor complications that the 
obstetrician is called upon to treat. By careful preparation of the 
nipple during the last month of pregnancy, and by extreme care to 
secure perfect cleanliness during the period of lactation, infection ot 
the breasts can almost surely be avoided. If it occurs, the first effort 
should be to limit its extent and degree, and to prevent, if possible, 
suppuration. The best means to accomplish this end are derivation 
of the blood from the mammary glands by an active purge, com- 
pression of the gland-substance, and support of the breasts by a 
suitable mammary binder. 

To these should be added, in the acute stage of inflammation, 
fomentations of very hot water, and later, the application of cloths 
wrung out in lead water and laudanum, renewed every three hours. 
Unless the infection has been of a virulent nature, and the dose of 
infective material large, this plan of treatment will almost surely 
dissipate the inflammation and prevent suppuration. 

The other infectious fevers of the puerperal state include the infec- 
tious diseases which can, under any circumstances, fasten themselves 
upon the adult female, and their treatment differs in no respect dur- 
ing the puerperium, unless there should be developed some local 
complications. 



Non-infectious Diseases of the Puerperium. 

Anomalies of Involution. — Super-involution, an exaggeration of 
that process by which the uterus is reduced to its normal size after 
labor, only manifests itself, as a rule, after the puerperal state is com- 
pleted, and, therefore, its treatment need not be further considered. 

Subinvolution, an arrested or retarded return of the uterus to its 
normal condition, and dimensions after labor, is one of the commonest 
complications with which the obstetrician has to deal in the manage- 
ment of the puerperium. The cause of subinvolution is always a 
local one. General conditions, as acute fevers and so on, have no 
influence whatever upon the process of involution, unless they are 
accompanied by some local complication. 

There are two causes which prevent the involution of the uterus 
which must be borne in mind when one is called upon to treat this 



526 DISEASES. 

condition. The involution may be prevented on the one hand by 
anything which calls an excessive amount of blood to the uterine 
body, as, for instance, small fibroids within its wall, or hypertrophied 
deciduous membrane remaining adherent to its inner surface. On 
the other haud, subinvolution may be the result of mechanical ob- 
struction to the contraction of the uterine walls and the reduction of 
its cavity to the normal size. As an example of this we have a re- 
tained placenta or a submucous fibroid or adhesions, dragging the 
uterus out of place and preventing its contraction, or most commonly, 
perhaps, an over-distended bladder and rectum. 

In those conditions which result in a hyperemia of the uterus the 
cause of an excessive blood supply must be sought out and removed 
before one can remedy the subinvolution. 

If small fibroids can be detected the administration of quinine, 
ergot, and strychnine, in pill form, has been found most useful. 
If practicable, a faradic current may be employed in addition to 
medication. If there is a hypertrophied endometrium retained 
within the uterus a curette will most quickly and effectually hasten 
involution. In cases of heart disease, in which the blood current is 
sluggish and dammed back into the large veins of the trunk, digitalis 
will be the most effective remedy to overcome the subinvolution. 
There may be an active hyperemia associated with inflammatory 
action, either in the uterine wall or upon its peritoneal covering, or 
in its annexa ; in this case the inflammation must be overcome by 
disinfection, the use of purgatives, and, possibly, the local application 
of hot water, before involution can be secured. When there is me- 
chanical obstruction to the return of the womb to its normal dimen- 
sions the hindrance must, of course, be removed before one can 
expect a good result from treatment. In the case of retained adherent 
placenta every effort must be made to remove the placental tissue. 
In the case of submucous fibroids their removal must be attempted 
if there is any hope of safely accomplishing it. 

There is no case of labor which does not leave behind, in the 
parturient tract, some injury to the maternal structures. Usually, 
these are slight in degree, manifesting no symptoms, and healing 
spontaneously. Occasionally, the injury done results in fistula, com- 
municating with the bladder or rectum, in deep granulating wounds 
in the vagina, or in ulcerated sores. 

In the case of fistula a cure can sometimes be effected without 
operative interference by touching up the edges of the fistulous tract 
with nitric acid in order to excite an outpouring of granulation tissue 
in the hope that it may plug up the opening. In deep tears, which 
have not been primarily united, application of a solution of nitrate of 
silver will hasten the cure and prevent infection of the wounded 
surface. If ulceration occurs the ulcerated spots are to be carefully 
watched and treated in the same manner. 

Haemorrhages from the birth-canal after labor depend upon a 



NON-INFECTIOUS DISEASES OF THE PUERPERIUM. 527 

number of well-known causes, which must be sought out and cor- 
rected before the bleeding will cease. Most frequently, the cause of 
a haemorrhage will be fouud in retaiued fragments in utero, which 
must be removed. Not infrequently displacements of the uterus will 
be found as a cause, and correction of the displacement will stop the 
bleeding. 

In interstitial bleeding, after labor, resulting iu haematoma, care 
must be taken to preserve the parts in as aseptic a condition as possible, 
while an attempt is made to limit the bleeding by the application of 
direct cold, preferably by means of a Barnes' bag dilated with ice- 
water, which must be removed from time to time in order to allow 
the lochia to escape. After rupture or incision of these blood tumors 
the cavity left behind must be carefully disinfected with the bichlo- 
ride of mercury solution or creolin, and, if necessary to control 
further bleeding, well packed with iodoform gauze. 

Of all forms of bleeding that which occurs directly after labor, 
in consequence of inertia uteri, known as post-partum haemorrhage, 
is the most frequent of occurrence, and the most alarming and 
dangerous in its manifestations and consequences. No one should 
attend a case of obstetrics without having in mind a clearly-defined 
programme to be put in immediate execution when called upon to 
deal with this frequent and dangerous complication. There are two 
indications to be met. First, to control the haemorrhage, and, second, 
to treat the after-condition. The first indication is met by the 
following plan of treatment : External stimulation of the uterus by 
kneading and rubbing through the abdominal walls, as is practised 
in Crede's method of expressing the placenta. 

Next carry the other hand into the uterus and remove any blood- 
clots, pieces of placenta or membrane that may be found there, while 
the internal surface of the uterine walls is irritated by the manipula- 
tions of the operator's fingers. 

Next apply a small piece of ice upon the abdomen externally and 
carry another piece the size of a. hen's egg into the uterine cavity. 
The use of cold must not be persisted in for more than a minute at 
most, for its ultimate action is depressing and relaxing. 

Next soak a clean linen handkerchief in vinegar, carry it up to 
the fundus and squeeze it out so that the vinegar shall run down 
over the uterine surface. 

Next, hot water at a temperature of 116° or 120° should be in- 
jected into the uterine cavity. 

Then if one happens to have the necessary appliances at hand (a 
small Gaiffe battery, which can be carried in an ordinary instrument- 
bag), a strong faradic current can be applied to the uterine muscle. 

Finally, as a last resort, the uterine cavity may be packed with 
long strips of iodoform gauze in the manner suggested by Diihrssen 
and carried out by a number of observers with gratifying success. 

Drugs, as the styptic salts of iron, and especially Monsel's solu- 



528 DISEASES. 

tion, have been recommended from time to time as intra-uterine 
applications in the case of post-partum haemorrhage, but they are 
dangerous, for the coagulation produced by them may extend far into 
the uterine vessels, and the clots must be broken up by putrefaction, 
exposing the patient to the danger of septic poisoning. This pro- 
gramme is to be carried out in the order given ; if the milder measures 
suffice of course the more radical plans of treatment will not be em- 
ployed. Excessive haemorrhage (post-partum) from lacerations along 
the genital canal can be controlled by well-placed sutures. 

Bearing in mind this plan of treatment it is almost inconceivable 
that an intelligent and skilful practitioner should lose a case of post- 
partum haemorrhage. 

The physician should give ergot in full dose by the mouth, and, 
if need be, hypodermically. (See page 151.) 

Treatment of the After-condition. — While the physician is busy 
controlling the haemorrhage, the nurse should administer a hypoder- 
mic of ether, if symptoms of shock or collapse are manifested. After the 
bleeding has ceased it is well to administer an enema of a pint of hot 
water, which brings up the patient's temperature, relieves the shock 
aud by its irritation promotes contraction of the uterine muscle. 
This should be succeeded by small doses of hot, strong brandy-and- 
water, and a little warm milk if the stomach will retain it. As soon 
as reaction is well established a half-pint of hot beef-tea should be 
administered and a hypodermic of \ grain of morphine given in order 
to secure quiet and rest and to get the stimulant qualities which this 
drug undoubtedly possesses. Occasionally measures must be adopted 
to retain enough blood within the large vessels and in the heart to 
prevent excessive cerebral anaemia or cardiac failure. This is best 
done by auto-transfusion ; that is, by bandaging the extremities toward 
the trunk in order to secure as large a quantity as possible of blood 
within the vessels of the trunk and brain. Actual transfusion of a 
■j 6 q- of 1 per cent, solution of common salt into the bloodvessels is 
required when there is profound exhaustion and depression after 
haemorrhage. It has been demonstrated that it is not necessary to 
throw this solution directly into the bloodvessels, as interstitial injec- 
tions seem to answer the purpose equally well. 

The milk secretion during the puerperal state presents abnormal- 
ities which call for treatment. One may have to deal with anomalies 
of quantity or quality. The most frequent anomaly of quantity in 
milk secretion is unfortunately one of defect. Insufficieut milk 
supply depends on a number of causes Perhaps the most frequent 
is a lack of development in the glandular tissue, and in this form of 
insufficient milk secretion no treatment can be of avail. Where the 
lack of milk is due to some intercurrent affection in the puerperal 
state the treatment must be directed toward this complication before 
the milk supply can be re-established in normal quantity. It may 
be the consequence of haemorrhages or of diarrhoea. It may be the 



NON-INFECTIOUS DISEASES OF THE PUERPERIUM. 529 

result of an acute febrile attack during lactation or of inflammation 
within the gland itself. Serious organic disease may also be a cause, 
and insufficient nourishment must be held accountable in some cases. 
Profound emotions exert an extraordinary influence upon lactation 
in altering both the quantity and the quality of the milk. It has 
long been supposed that the return of menstruation has a disastrous 
influence upon milk secretion. This, however, has been definitely 
disproven by careful observations recently conducted in Austria. 
The simple return of menstruation without complications has no 
apparent influence as a rule upon the quantity or quality of the 
woman's milk. In all the temporary diseases interfering with milk 
secretion described above, it should be borne in mind that on the 
disappearance of the abnormal general or local condition, milk secre- 
tion can be successfully re-established, even though it be intermitted 
for days or weeks. Electricity has been much vaunted of late as a 
remedy for insufficient lactation. It may be applicable in cases of 
torpidity of the mammary gland, or in those cases where lactation has 
been suppressed on the birth of a first child, and where the mammary 
gland therefore does not respond readily to the stimulus of subsequent 
births. This remedy will, however, often prove ineffective and disap- 
pointing. Quantitative anomalies in milk secretion by excess are not 
frequently met with. In the milder and simpler forms they can be 
managed by regulation of the diet and free purgation. Galactorrhoea, 
a constant flow of milk from the breasts, is one of the most stubborn 
forms of excessive milk secretion. Two measures can usually be 
relied on to give relief: firm compression of the mammary gland 
with the application of belladonna ointment, and the administration 
internally of iodide of potassium. In some cases of this sort milk secre- 
tion stops spontaneously with the return of menstruation, and in a 
certain proportion of cases a treatment to secure a discharge of 
blood from the uterus has been successful in stopping the flow of milk. 
Success has .been obtained with Simpson's plan of introducing a piece 
of caustic within the uterus in order to bring back the menstrual 
flow. Warm douches have been used successfully for this purpose. 
Electricity has been recommended to secure the proper contraction 
of the sphincter muscles of the lactiferous ducts, but as this is usually 
a result and not a cause of the galactorrhoea, the use of electricity 
must prove in the vast majority of cases ineffective. The long-con- 
tinued administration of ergot has been warmly recommended. The 
remedy should be tried, for its use seems rational. It has been 
demonstrated that all those drugs which bring about an increased 
arterial pressure in the parts promote milk secretion, while those 
which lower arterial pressure tend to diminish or even abolish the 
function. Chloral has been shown to be very effective in diminish- 
ing the quantity of milk. Therefore this drug is worthy of trial. 
It has recently been declared that antipyrine in 2J grain doses three 
times a day will diminish milk secretion. The drug, however, has 

34 



530 DISEASES. 

not been often enough tested to demonstrate its power. Quantitative 
anomalies in the milk secretion must often depend upon an ill-regu- 
lated diet. A fatty diet will diminish the quantity of milk ; a vege- 
table diet will diminish the caseine, and fat will increase the sugar; 
a diet rich in meat, especially if reinforced with alcoholic stimulants, 
will increase the fat and caseine, but will diminish the sugar. If the 
mother's milk is evidently disagreeing with the nursing iufant, a 
chemical analysis of it should be made and on the result rules regu- 
lating the diet should be adopted. The most common mistake in 
practice is to over- feed a nursing woman, especially with a milk diet, 
with the idea which prevails extensively among the laity that the 
cow's milk poured into the stomach appears again in the mammary 
gland. It is usually sufficient for a nursing woman to observe the 
ordinary diet which agrees with her under all circumstances, with 
the addition perhaps of a half-pint of milk midway between the 
morning and mid-day and mid -day and evening meals. Occasionally 
a wineglassful of malt at the mid-day and evening meals is a useful 
addition to the diet, and in anaemic patients the addition to the malt 
of 5 grains of pyrophosphate of iron will be an advantage. 

There is found in every pregnant woman some alteration in the 
constitution of the blood, which consists, roughly speaking, of a 
diminution of the red blood-corpuscles, and albumin and the 
iron in the blood, with an increase in the white blood-corpuscles 
and the watery element. In some cases this change is much 
exaggerated, until an intense degree of anaemia appears in the 
puerperal state which, in its severity, will simulate pernicious anae- 
mia, or some fatal form of blood-disease. The anaemia of puerperal 
women, however, even in exaggerated cases, usually yields to treat- 
ment in a most gratifying manner. After the prolonged use of 
Blaud's pills, the writer has seen the blood corpuscles rise from less 
than three to nearly four and a half millions, and the haemoglobin 
increase from 40 to 75 per cent, in a few weeks. In. some cases 
arsenic alone succeeds where iron fails completely. 



Eclampsia. 

To treat eclampsia intelligently and successfully it is necessary to 
understand its etiology as fully as modern knowledge permits. 
Although the subject needs more light from future investigation, 
enough is now known to justify the following statement : 

1. The cell activity of mother and foetus produces excrementitious 
substances which will surely prove virulently poisonous to the whole 
organism unless they are voided or made harmless by the excretory 
organs. 1 

1 Harold C. Ernst: American System of Obstetrics, vol. ii. p. 451. 



ECLAMPSIA. 531 

2. These organs in the childbearing woman are often inadequate 
to the disposal of effete material from the maternal and foetal body. 

3. Consequently, poisons, of a nature not yet demonstrated, are 
stored up in the maternal blood until, by cumulative action, their 
presence is manifested in the eclamptic seizure and other symptoms. 

4. The convulsions are probably the result of an acute cerebral 
anaemia brought about by violent contraction of the arterioles j pos- 
sibly by direct irritation of the brain substance. As a result of in- 
tense muscular action the circulation is interfered with and blood is 
determined to non-muscular regions, as the brain, lungs, kidneys, 
etc., to such a degree that the congestion of these parts becomes dan- 
gerous, leading to apoplexy in the brain, oedema in the lungs, and 
often a complete abrogation of renal function. 

The indications for treatment in convulsive seizures of this nature 
are plain : 

First, to attack the fons et origo mali, to eliminate the poisons 
from the blood as quickly and in as large quantities as possible. 
Second, to diminish nervous sensibility and lessen muscular power, 
in order to reduce the convulsions in vehemence, duration, and fre- 
quency. Third, if convulsions occur during labor, to save the infant 
without adding to the risk of the mother. Fourth, to guard the 
woman from injury during the attack. 

The first indication is met by venesection, diaphoresis and cathar- 
sis. By the first, one eliminates a certain quantity of poison along 
with the blood and relaxes the muscles. If there is sharp post- 
partum haemorrhage, or if the patient is from any cause weak and 
anaemic, bloodletting is not called for. In the ordinary case, how- 
ever, with full pulse, congested head, the veins standing out upon 
the neck and face, venesection is an undoubted advantage. It is 
not of itself enough. While the median basilic of one or both arms 
is being opened, some croton oil should be sent for ; 2 drops may be 
placed upon the tongue. Directions should at the same time be 
given to wring out three or, better, four old blankets in boiling 
water ; these are to be wrapped around the legs, trunk and arms, and 
well covered over with one or more dry blankets. The sweating thus 
induced is profuse. An ice-bag must be put to the head to prevent 
over-congestion of the brain. In this way one eliminates the cause 
of eclamptic convulsions as quickly and thoroughly as possible from 
the blood, directly and indirectly through the skin and bowels. The 
latter may be acted upon by J grain elaterium rubbed up in butter, 
or by compound jalap powder and calomel, instead of resorting to 
the croton oil. Pilocarpine seemed at one time an ideal remedy to 
secure diaphoresis in eclamptic cases, but it has lately fallen into 
well-deserved disrepute. It much increases the danger of pulmonary 
oedema and is too profound a depressant. It is no longer employed 
by experienced and educated obstetricians. The second indication is 
best met by an anaesthetic. Usually the convulsion first shows its 



532 DISEASES. 

approach in the eyes ; these should be closely watched, so that on the 
first symptom of the oncoming attack chloroform may be at once 
administered and pushed as rapidly as possible. Ether is inadmis- 
sible in these cases, for it is slow of action, congests the brain, and 
irritates the kidneys. Just before the woman is wrapped in blankets, 
1 drachm each of chloral and bromide of potassium in solution 
should be injected into the rectum. This may be repeated in an 
hour if necessary. Morphine, veratrum viride, and inhalations of 
nitrite of amyl, have their enthusiastic advocates in this connection. 
They may be held in reserve, in case the plan of treatment described 
needs reinforcement. 

If convulsions come on during labor, the child should be rapidly 
extracted as soon as the os is well dilated. Not before, because 
efforts to dilate the os would be very apt to increase the convulsions, 
and would attract the physician's attention from the woman's most 
threatening danger. Moreover the os dilates naturally with unusual 
rapidity during eclampsia. 

The only injury to be feared during eclamptic attacks is wounds 
of the tongue from the teeth. This can be prevented by inserting 
between the teeth a brush-handle wrapped in a handkerchief, or by 
drawing a towel into the mouth like a bit. Well-meaning but 
ignorant bystanders will sometimes throw themselves upon an 
eclamptic patient to restrain her convulsions by force. This should 
be forbidden. 



REMITTENT FEVER. 

This is sometimes called bilious fever, by reason of the violent 
bilious vomiting and jaundice often accompanying it. It separates 
itself from intermittent fever by the fact that the patient's condition, 
chiefly as regards temperature, does not have normal intervals, but 
has periods of only temporary improvement, or, in other words, the 
disease remits. 

For the proper treatment of this fever, three things must be borne 
in mind : 1. It is more dangerous than intermittent fever. 2. It is 
dangerous in the hot stage, not in the cold stage. 3. The patient, 
not having periods for complete or partial recovery, rapidly loses 
strength. The safety of the patient here depends upon the use or 
large doses of quinine to cut short the pyrexia! stage, the doses used 
being from 20 to 30 grains, preceded by a good-sized purgative dose 
of calomel, say 3 or 4 grains. If vomiting is too violent to permit 
of the retention of the quinine, it must be used by the rectum and 
hypodermically, and the stomach and intestines be swept out by the 
use of divided doses of Seidlitz powder (see Seidlitz Powder, page 
267). If purgatives are used, they should precede the quinine by 
twenty minutes, as otherwise the latter drug is swept out into the 



RHEUMATISM, ACUTE ARTICULAR. 533 

bowels, where it is useless by reason of its precipitation by the 
alkaline juices there present. If pyrexia is excessive, relief must be 
sought in the cold pack and autipyrine. 

The best treatment of the vomiting is the use of small doses of 
morphine, or 3 to 5 drop doses of the spirit of chloroform in 30 
drops or 1 drachm of cherry-laurel water. Aconite may also be used 
if the patient is stroug enough. (See Vomiting.) 

If the belly is tender, a turpentine stupe should be applied. (See 
Turpentine, page 288.) 

If intestinal haemorrhages occur, gallic and tannic acids or Mon- 
sel's salt, in the dose of 3 grains in hard pills may be used, and cold 
cloths be placed over the belly. (See Haemorrhage.) 

The treatment of convalesceuce consists in the use of tonics, such 
as quassia, columba, gentian, Huxham's tincture, arsenic, and purga- 
tives when needed, with attention to the kidneys, chiefly employing 
the potassium salts to keep them active. 



RHEUMATISM, ACUTE ARTICULAR. 

No better example of the fact that therapeutics is in advance of 
pathology can be adduced than the disease known as rheumatism. 
The therapeutist cannot tell how he cures the condition designated 
by this name, simply because the pathologist cannot tell what the 
cause of the disease is, and when this information is forthcoming 
from the one side an explanation will be immediately given by the 
other. This being the case, we must devote ourselves to the study 
of pure empiricism, and not to logical pharmacology. 

The treatment of acute articular rheumatism is divided into that 
devoted to the cure of the diseased process, and that directed to the 
relief of the pain and of the local manifestations of the disease. 

When an acute attack of rheumatism comes on, it is nearly always 
accompanied by a high temperature, a bounding pulse, and all the 
evidences of an active systemic disturbance following upon inflam- 
matory outbreaks, which, in this particular instance involve the 
joints. We may, therefore, use at such times the remedies which 
we have learned are best able to combat inflammation, namely, 
aconite and veratrum viride. So powerful are these drugs in the 
early stages of acute rheumatism that some persons have believed 
them to be possessed of a specific anti-rheumatic power. This is, 
however, highly unlikely, as they act no better here than in other 
inflammatory conditions elsewhere. 

The proper manner in which to use the tincture of aconite under 
these circumstances, in a strong healthy individual, is to administer 
3 drops at once in a little water and follow it by a teaspoonful of a 
mixture containing 5 drops of tincture of aconite and 2 ounces of 



534 DISEASES. 

water, every half hour until perspiration on the skin betokens circu- 
latory depression through the action of the drug. If this is not 
done veratrum viride in the same proportions may be used. The 
advantages of this treatment are numerous : first, it allays the fever ; 
second, it quiets nervous excitability ; third, prevents permanent 
changes in the joints involved ; and, last of all, aids in the produc- 
tion of a sweat. Whenever these drugs are employed the patient 
must be strong and hearty, not debilitated or weak, and it is to be 
noted that this treatment is not to be resorted to carelessly, and, 
finally, care is to be taken that the symptoms of depression from 
the drug and the disease combined do not become too severe. 
Where great exhaustion is primarily present, or ensues upon the use 
of depressant drugs, alcoholic stimulants are particularly needed. 

Along with these internal measures a solution of bicarbonate of 
sodium, 20 grains to the ounce, may be applied by means of lint wet 
with this solution to the joints involved, with relief to the sense of 
heat and burning, or, in other instances, ice-cold compresses may be 
tried. 

Immediately after the system has been thoroughly impressed by 
cardiac sedatives, or at once, and in their place, if the case is not seen 
at first, or is weak, the physician should resort to one of three reme- 
dies, namely, salicylic acid or its salts, antipyrin, or acetanilide. The 
general opinion of the profession seems to be that these three reme- 
dies stand in the order here placed in regard to their efficiency, but 
it is also true that one will often succeed when the other fails, and it 
is worthy of note that success or failure generally asserts itself 
rapidly — that is, the drug used gives relief in twenty- four or forty- 
eight hours, or fails. It is most important to remember that salicylic 
acid seems to protect the cardiac valves and the endocardium from 
the ravages of the disease more than do the other two newer remedies. 

Taking up salicylic acid first we find that its proper use is often 
misunderstood, and that it fails because of this fact. Whenever 
acute articular rheumatism appears the salicylic acid should be pushed 
in the same way that we use quinine in full dose on the advent of a 
malarial paroxysm. 

It is useless to give the drug in 5 or 10 grain doses three times a 
day ; it must be given in 20 grain doses morning, noon, and night, 
or not at all. If all the sweats are too severe, or the stomach rebels, 
the drug may be stopped, but not decreased in amount, unless for 
good reason. Further than this, if salicylic acid is used for two or 
three days in this way, and produces evidences of cinchonism, yet 
fails to alter materially the course or severity of the trouble, it should 
be withdrawn, as it will rarely, if ever, do any good after this time. 

Antipyrine and antifebrin may both be considered together since 
their action is identical in rheumatism. The author believes that 
antipyrine, while often relieving the pain more than the antifebrin, 
nevertheless does not act so favorably in decreasing the duration of 



RHEUMATISM, ACUTE ARTICULAR. 535 

the disease. The dose of the first should be 10 to 20 grains three 
times a day ; of the second, 4 to 8 grains at the same intervals. 

The studies of Guttmann with antifebrin in a very large number 
of cases of rheumatism, embracing all its forms, both chronic and 
acute, have given most encouraging results, and we have seen the 
drug act most happily in several cases which had refused to yield to 
the iodides and salicylates, and all of these cases were of the severe 
acute form, suffering intense pain from the articular inflammation, 
but devoid of any cardiac complications. It at once becomes evident 
that a drug such as antipyrine or antifebrin may do good- in a case 
of rheumatism in three entirely separate and distinct ways, any one 
of which may be active at once or all active together, hand-in-hand 
in the improvement of the patient's state. Any substance possessing 
strong antipyretic power must be of value under such circumstances, 
because of the lowering of the fever which follows its administration, 
with the resulting quieting of an excited system, and in putting aside 
the delirium associated with a condition of hyperpyrexia. Not only 
does such a drug act favorably in this manner, but the analgesic 
effects of such a substance must exert a powerful influence for good. 
By benumbing the sensibility of the patient to the excruciating pain 
consequent upon movement, and so putting aside the nervous wear 
and tear of sleeplessness and suffering the patient's state must im- 
prove, or, at least, not grow worse from the exhaustion of the long 
hours of agony. Further than this it would seem probable that 
antifebrin possesses a direct anti-rheumatic influence, allaying the 
diseased processes even in those forms where, pain being largely 
absent, the improvement must be real and not apparent, as a result 
of the relief of pain and gain in sleep. 

The intention of the author is not to extol the value of antifebrin and 
antipyrine in rheumatism to the exclusion of other means of relief, 
nor to recommend its use before the more thoroughly tried salicylates 
and iodides, but to draw to its standard a certain number of cases which 
persistently resist treatment of the ordinary stamp and which put 
the physician to his wit's end for a change of treatment, at least 
promising some chance of relief. Many of the readers of this book 
have doubtless seen such cases, and many of them must have learnt 
by sad experience that acute articular rheumatism is in many cases 
bound to run a course of so many weeks or days, do what we will. 
Under these circumstances nothing acts further than a palliative, 
and the patient and his friends become impatient for a change. We 
have found that antifebrin in such cases will often relieve the pain 
and so permit a refreshing sleep, in doses of from 4 to 8 grains three 
times a day, and that these amounts do not cause the excessive sweat- 
ing which the necessarily large doses of salicylate are sure to produce, 
sweats which leave the patient oftentimes almost dyspnoeic from very 
weakness. Whether this temporary relief produces such changes in 
the system as to permit of a better battle against the disease, or 



536 DISEASES. 

whether it actually counteracts the rheumatic poison, we know not ; 
but we do know that following its employment the relief is not only 
temporary, but often permanent, and that a very distinct step in ad- 
vance is made toward the close of the attack if auy influence at all is 
felt. 

A very efficient substitute for salicylic acid is the oil of gaultheria 
(wintergreen) which contains about 90 per cent, of the salicylate of 
methyl. The dose should be 10 to 20 drops on a teaspoonful ot 
sugar or in capsule or emulsion three times a day, after meals. 

Passing from what may be appropriately called the coal-tar treat- 
ment of rheumatism, because all the drugs so far named for internal 
use have had such a source, we come to a line of remedies heretofore 
largely used in rheumatism in place of the newer compounds, but 
which are not so commonly employed to-day. 

These remedies act, as a rule, in the subacute forms of rheumatism 
or in the cases where the first group fail because the disease is obsti- 
nate. Of these the chief is the iodide of potassium followed by the 
acetate, bicarbonate and citrate of potassium. If the iodide is used 
the following prescription is of service : 

R. — Potas.. iodid ^j. 

Syr. sarsaparillse comp ^vj. 

M. — S. Dessertspoonful t. d. after meals. 

Or, if preferred, 20 to 30 grains of the bicarbonate of potassium 
may be used every four or five hours in water, flavored with cinna- 
mon for the sake of the taste, or the citrate of potassium, which is 
more agreeable, may be taken in equal amount. Sometimes a little 
colchicum added to the prescription given above may be useful if 
the case is very obstinate, as follows : 

R. — Potas. iodidi %] to !|ij. 

Vin. colchici rad. ...... f.^ss. 

Syr. sarsaparillae comp. . . . . q. s. f'Jvj. 

M. — S. Dessertspoonful t. d. after meals. 

The other drugs used in acute rheumatism are numerous, but only 
a few of them deserve attention here. There is abundant evidence 
on record that full doses, 10 to 30 drops of the fluid extract of cimi- 
cifuga if given every five hours will decrease the redness and pain ot 
the joints and shorten the attack in some cases. Again, certain species 
of rhus, as Rhus toxicodendron, are useful if fresh preparations are 
at hand. The dose of Rhus toxicodendron is ^ to 1 drop of a tinc- 
ture made by adding 1 part of the fresh leaves of poison-ivy to 2 
parts of alcohol, this dose being taken three times a day. Where the 
pain seems particularly severe at night this drug is very valuable, 
according to many careful students of therapeutics. 

Nearly every case of acute rheumatism will do better if a strong 
mixture of lemon or lime-juice and water be taken daily in large 
quantities. 



RHEUMATISM, CHRONIC. 537 

The heal remedies in rheumatism are chiefly counter-irritants and 
sedatives. Thus small or large blisters applied around an inflamed 
joint after the general systemic excitement is passed, may be of great 
value in restoring the suppleness of the joint and in aiding in the 
absorption of the effusion. The remaining local treatment consists 
in thoroughly painting the inflamed parts with tincture of iodine, if 
blisters are not used, and in the application of veratrine ointment 
or iodine ointment around the joint. (See Veratrine, p. 291.) 

A most valuable application to the inflamed joints of rheumatism 
either during the acute stage or afterward when they remain swollen 
and enlarged, is : 

R. — Ichthyol . giv to ^j. 

Adepis ........ 3 ij. 

M. — S. Apply about the part, and rub in well. 

The presence of high fever is to be controlled by the same meas- 
ures identically as is the high fever of any other disease, by antipy- 
retics, by the cold pack, cold bath, or sponging with tepid or cold 
water. 

Salol, which is dissolved and absorbed solely in the intestine 
through the action of the juices there present, has been used in the 
place of salicylic acid with success ; but it is worthy of note that, as 
it contains 40 per cent, of carbolic acid in addition to the salicylic 
acid, its use in large amounts is dangerous. 



RHEUMATISM, CHRONIC. 

Chronic rheumatism is one of the most difficult and obstinate dis- 
eases w r ith which we have to deal. In some cases the acute form 
just considered merges slowly into the chronic form ; or, in* other 
instances, the disease gradually comes on, increasing, it may be, by 
exacerbations, or by gradual progression. The treatment of chronic 
rheumatism is somewhat different from that of the more acute forms, 
and approaches that of gout in some of its therapeutical indications. 
In other words, the salicylates are not so useful in these cases as are 
the iodides and colchicum, so that, in the majority of instances, the 
prescription of iodide, sarsaparilla, and colchicum, given on page 536, 
is indicated. When any anaemia or weakness is present cod-liver oil 
is often of great service, and it is worthy of note that this useful 
nutritive remedy was first brought into therapeutics by the fish-wives 
of Holland, who found it useful in the attacks of rheumatism to 
which their husbands were subjected through exposure. 

When the oil is thoroughly rubbed into chronically inflamed 
joints it is often useful, as well as when taken internally. 

The same forms of counter-irritation are useful in chronic rhema- 
tism as in acute rheumatism, and a very valuable therapeutic measure 



538 DISEASES. 

in these cases is the use of the Russian or Turkish bath, or an 
improvised sweat by means of a lamp and a blanket. (See Heat, 
page 320, and Cold, page 304.) Liniments are always called for for 
two reasons : First, they relieve pain and do good to the parts, if not 
from their medicinal properties, at any rate from the rubbing which 
accompanies their application ; second, because they give the patient 
something to do, or to have done, and therefore impress him with an 
object lesson that his attendants are attentive and alive to his suffering 
and need of sympathy and care. 

Among the lower classes the belief in liniments is very wide- 
spread, and their use will often instil into the minds of the friends a 
far greater confidence than the most logical of treatments with the 
liniment left out of the list of remedial measures. 

The following liniments will be found very useful under these 
circumstances : 

R. — Tr. aconit 

01. terebinthinse 

Tr. opii 

Liniment, saponis . . . q. s. ad 

M. — S. Poison. Use as a liniment three times a day. 




Or, 



R. — Aq. ammonii fort f^iv- 

01. cajuputi f.^j. 

Tr. belladonnse f^jtof^ij. 

Liniment camphorse . . . . . q. s. f^vj. 
M. — S. Poison. Use as a liniment. 



Or 



I£. — Tine, opii ~j 

Tine, aconit. I . . . . . && fgiv. 

Aq. ammon. fort. J 

Lin. chloroformi f ^j. 

M. — S. Poison. Use as a liniment to chronically inflamed muscles or joints. 

In other instances the greatest relief is obtained by employing the 
following ointment of veratrine : 

R.— Veratrinse ") -- ~. 

Hydrargyri protiodidi j J ' 

Ung. petrolei ^j. 

M. — S. Use as an ointment over the joints. 

The ointment ought not to be widely distributed, and the pulse 
should be watched, as the veratrine may be absorbed, and depres- 
sion of a severe character set in. 

For the reduction of enlargements of the joints due to the dis- 
ease, and accompanied in some cases by pain, in others without pain, 
the following ointments are serviceable : 

R. — Ung. iodinii ^j- 

Adepis . . . . . . . . ■ . 3 ivt0 3J- 

M. — S. Apply locally. 



RICKETS. 539 



Or, still better 



R.— Ichthyol . . . ^ivtogj. 

Adepis . _ Jj. 

M. — S. Rub into the joints thoroughly. 

Ichthyol is, however, certainly the most efficient remedy for the 
joints that we have. 

The employment of red flannel over inflamed joints is no better 
than the use of white and it is never " medicated," as claimed in 
the stores. The only advantage of red flannel is that, as it is dyed, 
the wool is often better for not being thoroughly bleached. The 
disadvantages of red flannel are its staining the clothes and the 
possibility of its producing irritation of the skin. 



RICKETS. 

Rickets may be defined as a state of the body of an infant or child 
in which there is a deficiency of the normal salts of the bones and 
tissues. Generally the term is applied solely to designate bony 
troubles, but every practising physician sees cases where the manifes- 
tations of rickets are emphasized in gastro-intestinal troubles rather 
than in bony deformities. The chief causes of rickets in children, 
aside from the presence of any disease such as scrofulosis, is inanition, 
that is, non-nutrition of a specialized form, or, in other words, bone 
salts starvation. This may be after or before birth, and it is quite com- 
mon to see children, born of mothers ill- fed or whose assimilation of 
salts is defective, with soft bones or a distinct tendency to rickety 
development. 

The treatment of rickets is therefore largely dietetic and devoted 
to the improvement of the food and digestion. No part of the body 
fails in force more than the digestive apparatus in the presence of 
this disease, probably because the alkalinity of the blood is altered, 
and partly because the stomach cannot secret properly formed juices 
from imperfectly supplied glands. 

The medicines to be used in rickets are general tonics, digestive 
tonics and stimulants, and bone tonics and stimulants, such as salts 
of lime and phosphorus. The general tonics are quinine, cod-liver 
oil, nux vomica and iron, while the digestive tonics are the simple 
bitters and mineral acids. The bowel tonics and stimulants are lime 
salts, phosphorus, phosphate of zinc and physostigma. 

The following tonic may be useful in young children of one year 
or more : 

R. — Tr. cinchon. comp. . . . . . . fspj. 

10 drops t. d. after nursing. 



540 DISEASES. 

If this is placed in a little water sweetened slightly with saccharin 
it will not be greatly objected to. 

A very useful preparation is the following : 

R. — Olei morrhuse f ^ vj. 

Syr. calcis lactophosphat. \ -. fz--- 

Liq. calcis J o J* 
M. — S. J to 1 teaspoonful two or three times a day, 

Or a preparation made by Reed & Carnick known as " cod-liver oil 
and milk " which is partly predigested and is said to contain 50 per 
cent, of cod-liver oil and hypophosphites. Half a teaspoonful of 
this preparation slowly increased to a teaspoonful after the morning, 
noon, and evening meal is often of great service. Nux vomica is 
generally so bitter as to be rarely administered to young children, 
and when given only J to J of a drop of the tincture should be 
used, three times a day. 

Where a distinct scrofulous tendency exists and ansemia is present 
small doses of the syrup of the iodide of iron is of service, and -^ 
to 1 drop may be given three or four times a day to a child of six 
months or a year, thus : 

R. — Syrupus ferri iodid, " gtt. iij. to xx. 

Aq. dest q. s. f^iij. 

M. — S. Teaspoonful every four or five hours during the day. 



Or 



R. — Syr. ferri iodid gtt. v. to xx. 

Syrup, simplicis . . . . . q. s. fjfiij. 

M. — S. Teaspoonful t. d. after meals. 

The salts of lime and sodium are of direct benefit to the bones, 
forming by their presence in health a large proportion of the osseous 
system, and therefore they may be considered as foods rather than 
drugs. Very often their administration to nursing mothers or 
pregnant women saves the maternal teeth from caries and preserves 
the general health of the mother and child. The following prescrip- 
tion may be used : 

R. — Syr. calcis lactophos f^i v « 

S- Teaspoonful t. d. after meals. 

Or, if something still more active is needed, 

R. — Phosphori gr. £. 

Olei amygdalae . . . . . . . fgvijss. 

Pulv. acaci?e f^iv- 

Sacchari alb. . . . . . . . f^iv. 

Aq. dest f gx. 

M. — Ft. in emulsio. S. Teaspoonful t. d. after meals. 

The reasons for the use of phosphorus are clear, from what has 
been said of that drug when speaking of it elsewhere in this book 
(p. 247), since it acts as a direct and powerful stimulant of bone 
growth. 



SCARLET FEVER. 541 

The following prescription by Kassowitz, who has used the drug 
very extensively in this affection, will be found useful : 

&. — Phosphori gr. J. 

Olei morrhuae . . . . . . . f^vi. 

M. — S. Teaspoonful t. d., after food. 

Phosphate of lime and phosphate of sodium are valuable remedies 
in rhachitis. They are never to be used in large doses, because they 
will not be assimilated, and will only disorder the stomach. The 
proper dose of each is 1 to 2 grains, placed in the milk, where their 
presence will not be noted. 

The ventilation of the rooms where a child prone to rickets is 
kept should be excellent, not too hot or cold, and free from draughts. 
A cool sponge bath is useful at night if the patient is strong enough, 
or a good rubbing with salt and whiskey (1 drachm of salt to a pint 
of whiskey) is of still greater service. 

Special attention should be paid to the development of the muscles 
by massage and passive movements, as these parts are always weak. 
Walking must not be allowed too early, as it may cause bony 
deformities. 



SCARLET FEVER. 

This disease, the most frequently fatal of all the exanthematous 
diseases of childhood, needs the greatest watchfulness and treatment. 
Complications constantly arise, requiring skill on the part of the at- 
tendant, and it is upon his success in treating these outbreaks of 
danger, as well as in the general direction of the case, that the life of the 
patient chiefly depends. It has been claimed by certain practitioners 
that one or two remedies which they have used act as abortifacients 
of the attack, decreasing its severity, duration, and the probability of 
complications. Thus, one European physician has used salicylic acid 
with wonderful results, if his claims are just, for he found it to pre- 
vent all complications, and even to remove them when present. He 
gives throughout the entire attack, and for some days after defer- 
vescence has ensued, the following : 

U. — Acid, salicylic. ....... gr. xlviij. 

Aquse dest f ^ i j . 

Syr. aurantii q. s. f§iij. 

M. — S. Teaspoonful every hour during day and every two or three hours at 
night. 

In this country Wilson has employed chloral throughout the entire 
attack with asserted good results in the following manner, but in 
our opinion Wilson's method is not the best for most cases, unless 
the nervous manifestations are very marked, when the chloral treat- 
ment is of great value. 



542 DISEASES. 

The plan is as follows : " So soon as the patient is suspected or 
known to be developing scarlatina, a laxative dose of calomel, pro- 
portionate to the age and general condition, is administered. Shortly 
thereafter chloral is given in moderate doses, at intervals of two or 
three hours, or louger, throughout the attack. The dose varies with 
the age of the child ; the frequency of its administration depends 
largely upon its effect. To infants of two or three years a dose ol 
from 1 to 2 grains may be given, the dosage being gradually in- 
creased with older children ; that for adolescents reaching 5 grains. 
The tranquillizing and sleep-producing effects of the drug are, in 
most instances, promptly realized, the patient falling into a condition 
of quietude instead of the restlessness and jactitation which are so 
distressing in the well-developed disease. 

The repetition of the dose should not be more frequent than is 
necessary to maintain this condition of quietude, a condition from 
which the patient may be easily aroused, and into which he quickly 
relapses when left undisturbed. It is neither necessary nor desirable 
to push the drug to the establishment of a deeper sleep. Profound 
narcotism is, of course, to be avoided. The patient may thus be 
kept in a condition of light repose throughout the whole duration ot 
the fever. By this means not only is there obtained relief from the 
restlessness and distress of the active period of disease, but much 
wear and tear of the nervous system, and some exhaustion from 
muscular effort, are prevented. Delirium is controlled ; the itching 
and burning of the skin, due to the eruption, are allayed ; in a word, 
the greater number of the distressing symptoms of the disease are 
favorably influenced by the cautious and prolonged administration ot 
chloral hydrate in efficient doses. 

As a rule, the drug is easy of administration, and well borne by 
the stomach'. Wilson has found its acrid after-taste best masked by 
its administration in Aubergier's syrup of lactucarium diluted, thus : 

R. — Chloralis gr. xxx. 

Syrup, lactucarii (Aubergier) ) _. fX 

Aquse / " ' • aa t^ss. 

M. — S. A teaspoonful in iced water every two, three, or four hours. 

The administration of nourishment immediately after the medi- 
cine is desirable. The sleep-inducing properties of the drug manifest 
themselves rapidly, but are not prolonged ; therefore, its repetition 
at intervals of two or three hours is called for. 

From the very beginning of an attack to its end, unless diabetes 
comes on, the child should be supplied with plenty of pure water, 
and, if possible, this w r ater should be obtained from a spring con- 
taining a low percentage of solids, as Poland water, which is widely 
sold throughout the country. If this is impossible, then Vichy water 
may be employed, or it may be used by obtaining the granulated 
Vichy salts sold by most large drug firms, and adding this in small 



SCARLET FEVER. 543 

amounts to pure filtered water. This makes an effervescing draught 
which may be taken while bubbliug or not, as the child desires. 
The object of this treatment is to flush out the kidneys, and so to 
dilute the effete matters generated in the body by the fever and the 
germs of the disease that they lose, to a great extent at least, their 
poisonous and irritating powers. 

The convulsions which sometimes usher in an attack are to be 
treated by 5 grain does of chloral and 10 to 20 grains of bromide of 
sodium for a child of five to eight years. The convulsions of the 
advanced stages are often ursemic, and must be so treated. 

The further treatment of the disease rests upon the symptoms' 
alone. We cannot cure the patient by the use of remedies, but we 
can do much toward making the pathway to health smooth and free 
from pitfalls and obstructions. 

Probably the most common complication calling for treatment, 
when the kidneys have been treated in the way just spoken of, are 
high temperature, or fever, and sore-throat, or angiua. The fever is 
to be controlled in these cases in precisely the same way that it is in 
all other conditions in which it is present. It is best to attempt to 
keep it clown below 101°, or at least below 102°, by tepid sponging, 
which also allays the itching of the skin ; or, if the fever still rises, 
by the use of colder water, or even the cold pack, if the parents will 
allow it. Generally the popular fear that the application of cold to 
the surface will drive the eruption " inward " is so strong as to make 
the cold pack objectionable in the eyes of the friends ; but, if the 
temperature reaches 105°, the physician must assert the fallacy of 
this belief, and insist on its use. (See Cold Pack, page 313.) If 
suppression of the rash does occur, we must use the wet pack. Anti- 
pyrine and antifebrin, to be sure, may both be used, but it is worthy 
of note that each of these may produce collapse, or other complica- 
tion, if large doses are necessitated by obstinate high temperature ; 
and, if these complications ensue, alcohol will be indicated. Quinine 
has been highly recommended as an antipyretic in scarlet fever, but 
it is of little value in the majority of cases, simply disordering the 
stomach and irritating the kidneys, if used in doses large, enough to 
be effective. Where the head seems particularly hot and the fever 
is high, an ice-bag or a head- coil of rubber tubing is to be employed, 
through which may circulate water at whatever temperature is 
thought best. 

The treatment of the sore-throat of scarlet fever is an important 
part of the care of the child in many cases. Small pellets of ice may 
be held in the mouth, and an ice-bag applied to the outside of the 
throat. This is done by finely breaking up some ice and placing it 
in a thin India-rubber bag about the neck, the surface of the bag 
being covered by a cloth, to prevent too rapid melting of the ice and 
the wetting of the clothes by the condensation of moisture on the 
face of the bag. This should be used during the entire attack, if 



544 DISEASES. 

needed, and renewed as often as it becomes at all warm from the 
heat of the body. By this means the redness of the fauces and the 
swelling of the glands of the neck are prevented or relieved. Chlo- 
rate of potassium may be used in a spray or on a swab, but never 
internally, owing to its irritant effects on the kidneys and stomach 
and its general influence on the blood. 

In some cases where the eruption fades, or is never very promi- 
nent, it is of the greatest importance that it be made active, as under 
these circumstances the child may be placed in the warm wet pack, 
and, if the head is very hot, cold applied to the vertex and throat, 
while the body is enveloped in the blanket. (See Wet Pack.) This 
often brings out in an hour or two a bright scarlet rash, and the 
child falls asleep and wakes up free from delirium and high fever. 

The itching and burning of the skin in many cases of scarlet fever 
are annoying symptoms, and they may become really dangerous. The 
author has recently carried out a series of experiments showing that 
fever of high degree can be brought on solely through nervous irri- 
tation, thus explaining a fact long well known to clinicians, namely, 
that the relief of this dermal irritation in scarlet fever may be followed 
by a fall of temperature. To relieve this symptom it will often be 
found advisable to cover the entire skin with a thin layer of vaseline 
or cosmoline, or benzoated lard, or, in other cases, as an antiseptic 
and local anaesthetic carbolic oil may be applied (2 drops of car- 
bolic acid to each 2 ounces of olive oil). In other cases almond oil 
may be used. 

If nephritis comes on and is a pressing condition the greatest care 
is necessary, and the object of the physician must be to make the 
skin, disabled as it is, carry out a sufficiently active eliminative func- 
tion to relieve the kidneys of any strain, to relieve dropsy, and to 
aid in the removal of effete matter by catharsis. These effects are 
best attained by the use of pilocarpine ; ^ grain by the mouth, to a 
child often years may be used, or y 1 -^ grain hypodermically. If 
cardiac weakness exists this cannot be done and w T e are forced to the 
use of from 5 to 10 grains of compound jalap powder to a child ten 
or twelve years, to which should be added 10 grains of bitartrate ot 
potassium to increase its efficiency. Sweating may also be produced 
by the employment of heat obtained by the use of bottles of hot-water 
or hot bricks placed about the patient, who is first wrapped in blankets 
so that the bottles cannot burn the skin and so arranged that sweating 
will come on. The thermometer must be placed in the mouth to 
foretell any danger from heat-stroke if the sweat should fail to 
appear 

The after-treatment of scarlet fever, during convalescence, consists 
in the use of Basham's mixture or the tincture of the chloride of iron 
and in the employment of simple bitters, strychnine, or quinine. 
Fresh air, sea air, or mountain air are useful, and colds or exposure 
to cold air or draughts is to be carefully guarded against. 



SCIATICA. 545 



SCIATICA. 



Sciatica is an exceedingly obstinate affection, in the majority of 
cases resisting the best treatment for weeks. It seems to be due to 
rheumatic taint in the majority of instances and may sometimes be 
cured by the'remedies used and described under the heading of acute 
or chronic rheumatism. In other instances it is due to injury or 
jarring of the nerve, as by heavy persons stepping off from a high 
step to the hard ground. Thus the most obstinate case ever seen by 
the writer was one in which a stout man weighing about 250 pounds 
acted as "coupler" on a switching engine, and though wonderfully 
agile for his weight provoked the disease in the leg on which he 
always first struck the ground when jumping from the platform of 
the moving locomotive. 

The treatment for all cases is both internal and external. The 
internal treatment may be the same as that already described under 
acute or chronic rheumatism or in other instances consist in the 
use of large doses of bitartrate or citrate of potassium, 40 grains 
three times a day in plenty of water to aid in the maintaining of free 
kidney action. At the same time the amount of coffee and tea should 
be cut down as much as possible, and lemonade, strongly acid, be 
taken freely during the day. If the pain is very excessive, morphine 
should be given, or antipyrine or antifebrin may be used. 

The local treatment of sciatica is quite various. One of the favorite 
methods is to inject deeply into the flesh, just over or about the exit 
of the nerve from the pelvis, 10 to 20 minims of chloroform, while 
other physicians prefer acupuncture, the needle being driven down 
until the sheath of the nerve is punctured. Still another useful 
method is to take a strong glass rod with a round, smooth end, and 
after anointing the skin over the course of the nerve with a little 
ichthyol ointment or lard, to pass the end of the rod back and forth 
over the tender area, using as much pressure as can be borne. By 
this means massage or pressure on the nerve is accomplished. In 
other cases the daily use of an ether or rhigolene spray over the part 
is effective, or kataphoresis may be resorted to. 

The liniments recommended in chronic rheumatism may be tried, 
and cod-liver oil is of service in obstinate cases. Sometimes nerve- 
stretching must be resorted to. 

Deep hypodermic injections of chloroform, 10 to 30 minims, may 
be made toward the nerve, or, instead of the chloroform, ^ to J grain 
of morphine in 30 minims of water, distilled and sterilized, may be 
used with equally good results and less danger of sloughing. 



546 DISEASES. 



SCLERITIS. 



Scleritis, or inflammation of the sclera, consists in a bluish-red, 
somewhat elevated patch, with implication of the overlying episcleral 
tissue (episcleritis). In the earlier stages pain and photophobia, if 
present, require atropine and boric acid and compresses of hot water ; 
later, the infiltration maybe subdued with yellow oxide ointment, 
associated with massage. If the disease spread and implicate the 
cornea and iris, the treatment useful in ordinary iritis is indicated. 
In stubborn episcleritis, without iritis, which does not yield to these 
measures, eserine, usually accompanied by pilocarpine sweats, should 
be tried, and even the actual cautery has been recommended. The 
disease in many instances is associated with rheumatism, syphilis, 
scrofula, anaemia, and menstrual disorders — these must always receive 
the needed constitutional treatment, especially if iritis or keratitis 
ensue. Scleritis is a disease hard to eradicate and subject to frequent 
relapses. 

SCROFULOSIS. 

Scrofulosis is to be treated by hygienic measures rather than drugs ; 
fresh air, residence by the sea-side, proper out-door exercise, massage 
and dietetics, all take precedence of medicines. 

If these necessary adjuncts to a cure are obtainable the prognosis 
is fair, to say the least, and the following drugs may be used, all of 
them being devoted to the improvement of the general health, and 
not to any direct influence over the scrofulous tendency in itself. It 
is hardly necessary to state that cod-liver oil, or its supposed active 
principles combined under the name of morrhuol, is, perhaps, the 
best remedy of all. The oil should be given in emulsion, being first 
pancreatized and so prepared as to be somewhat palatable by the 
addition of flavoring substances, if the child is old enough to appre- 
ciate such flavors. In young children, while distaste to the oil is 
often shown at first, a liking for it rapidly develops, so that the writer 
has seen children cry for it when, through his orders, the oil was dis- 
continued. It is nearly always best to combine the lactophosphates 
or the hypophosphites with the oil when it is given in these cases. 
Whenever anaemia is present syrup of the iodide of iron is useful in 
from 1 to 10 drop doses, according to the age of the child, as fol- 
lows : 

R. — Syr. ferri iodid. . . . . . . gss to f^i. 

Aq. dest q. s. f jfiij. 

M. — S. Teaspoonful in water t. d., after meals, to a child of one year. 

In these same cases -g 1 ^ grain of arsenious acid or the same amount 
of corrosive sublimate may be given to a child of three or four 



scurvy. 547 

years, or half these amounts to a child of one year, by using the 
following solutions : 

R. — Acid, arseniosi ....... gr. T ^- to gr. i. 

Aq. dest f ^ i j . 

M. — S. Teaspoonful every five hours, after food. 

R. — Hydrarg. chlor. corros. £ r - To to !• 

Aq. destil f Jij. 

M. — S Teaspoonful every five hours, after food. 

The use of the iodides is generally contra-indicated in those cases 
where softening and breaking down of the glands are going on 
rapidly. In their place we may employ the phosphates of lime or 
sodium in from 1 to 2 grain doses several times a day, and if suppu- 
ration is active the sulphide of calcium, given by placing 1 grain of 
it in half a tumblerful of water and giving a teaspoonful hourly. 
This mixture should be made fresh every day to prevent its becoming 
oxidized. 

Where enlargement of the cervical glands takes place iodine oint- 
ment, diluted with one-half of lard, should be well rubbed in twice daily, 
but stopped at once if any signs of softening or fluctuation appear, 
or if the skin becomes reddened. Where these enlargements are 
persistent, ichthyol ointment is to be rubbed in as follows : 

R. — Ichthyol t zj to ij. 

Adepis . . 3J. 

M. — S. Apply locally. 

If this is not followed by the cure, the gland should be excised 
or scraped and packed with iodoform as in the majority of cases they 
will be found to be distinctly tuberculous. 



SCURVY. 

Scorbutus is dependent so largely upon dietetic lawlessness and its 
cure is so completely dependent upon the use of proper foods that 
almost no drugs are to be employed in its treatment. The avoid- 
ance of all salt meats, or more important still, the avoidance of those 
foods, be they what they may, which have caused the disease in a 
given case, is to be practised. 

The only remedies particularly indicated are lemon-juice or lime- 
juice, or citric acid, the latter being far less valuable in all cases than the 
juice of the fresh fruit. Where lemon-juice causes indigestion, this 
effect may be avoided by boiling the lemonade and allowing it to 
cool. The boiling precipitates certain poisonous and irritating albu- 
minoids and the supernatant liquid when taken away is devoid of 
any evil influence, and may be cooled and sweetened to suit the taste 
of the individual concerned. 



548 DISEASES. 



SHOCK. 



The medical treatment of shock is very important, and the life of 
the patient depends upon its proper care by the attendant, but before 
describing the treatment it is in place to consider the causes of the 
condition and the state of the patient so that we may understand the 
methods indicated. Every physiologist recognizes the fact that the 
body, particularly in its most vital parts, is controlled by inhibitory 
and accelerator nerves or nerve cells, which govern the functions of 
every organ. Normally these two forces of inhibition and accelera- 
tion act in such a way as to be perfectly balanced, but abnormally 
they may either of them become excessive and overcome the other. 
Further than this we must remember that all conditions of great 
functional activity are ultimately followed by a reaction which 
amounts to depression or exhaustion. 

Shock consists in an overstimulation of the inhibitory apparatus 
of the heart and the respiration, which is ultimately followed by ex- 
haustion of inhibition so that the pulse and breathing become rapid 
and shallow instead of slow. Various degrees of shock can be readily 
recognized and the severity of the condition always depends upon 
the constitution of the individual. Every one has heard a nervous 
Avoman say " You frightened me so that my heart stood still, " and 
again a moment after " Just feel how fast my heart is beating," and 
we all of us know how any severe and sudden shock causes these 
changes to some degree in the pulse. The same mechanism is the 
cause of shock in railway or other injuries, only it is much more 
severe, owing to the actual injury received, and its accompanying 
terrors. Many of the readers of this book probably know that a 
violent blow upon the belly walls, just over the solar plexus, will 
cause death, even in so large an animal as the ox, and every boy has 
had the " breath knocked out of him" by a blow of sufficient feeble- 
ness not to be lethal in its influence. When a dog or other animal 
is examined after such a death, the heart is always found in wide 
diastole, because the excited vagus nerve has held it open and pre- 
vented contraction until the absence of blood in the brain results in 
death. 

This period of inhibitory excitement, when it occurs in man with- 
out being severe enough to cause death, speedily gives place to inhib- 
itory exhaustion and we have a rapid pulse from inhibitory palsy, 
while through the palsy of the vaso-motor system the bloodvessels 
are relaxed and the normal resistance to the heart is taken away. 
The heart beats wildly and fast for the same reason that a locomo- 
tive's wheels fly round when the track is slippery, or in other words, 
normal resistance is lost. 

The capillaries in the second stage of shock are dilated and the 
skin is relaxed, moist, and cold from excessive dissipation of heat. 



SMALLPOX. 519 

This is the more proloDged stage of the two and they both need active 
treatment. 

The patient will rarely be seen in the first stage of shock, simply 
because by the time the physician reaches him the second stage will 
have come on. In either event, the principal things to be done are 
the administration of ■£$■ to -^ grain of atropine hypodermically, and 
the application of external heat to maintain the bodily temperature, 
the fall of which is a factor of great importance, but generally over- 
looked in attending to an operation or other measures. The use of the 
atropine is peculiarly a triumph of therapeutics and rests upon logical 
deduction. It will be remembered that atropine in full dose acts as 
a depressant to the vagus nerve, and as this nerve is over-active in 
the first stage the drug acts as a sedative to it. This is, however, a 
comparatively unimportant fact, for it is another action of atropine 
which makes it valuable. If the vagus be very much stimulated, a 
safe dose of atropine cannot quiet it, but in the second stage, which 
we most commonly have to treat, a safe dose does not act upon the 
vagus but upon the vaso- motor system, and by preventing the dilata- 
tion of the bloodvessels of the body thereby provides blood-paths of 
normal tone and tenseness, which do not hold all the blood in stag- 
nant pools where it is not needed, but carry it to the brain and vital 
parts. Digitalis is a useful adjuvant to atropine because of its 
powerful vaso-motor and cardiac influence. Twenty drops of the 
tincture should be given hypodermically and repeated in an hour if 
the pulse does not show the influence of the drug at the end of that 
time. 

The application of heat in the form of hot-water cans, hot bricks 
or bottles must not be forgotten, care being taken that the patient is 
not burnt. (See article on Heat, page 320.) 



SMALLPOX. 

The treatment of smallpox is not specific, simply because it is one 
of those diseases which run a given course, and which we cannot 
abort. We can only treat the various symptoms which present 
themselves, and by the modification of these manifestations prevent 
complications and sequelae to some extent. The fever is to be treated 
as is any fever of this class. Often it can be allayed by a mixture 
containing tincture of aconite, spirit of nitre, and spirit of Mindere- 
rus (liquor ammonii acetatis), while the headache or backache may 
be controlled by antipyrine or acetanilide. Insomnia and restlessness, 
if excessive, are to be quieted by the bromides or chloral, care being 
taken that the doses of the latter are not large enough to depress 
the heart. It must be remembered that the time of onset of the 
secondary fever, the eighth day, is one of grave import to the patient. 



550 DISEASES. 

Before its arrival the treatment of the case must be so managed that 
strength is saved for this strain, and tincture of the chloride of iron, 
in 5 to 10, or even 20 drop doses, may be resorted to give strength 
to the patient and to affect specifically the pysemic fever. The pulse 
should be watched, and if it flags, brandy and whiskey should be 
freely but wisely used. 

The peripheral irritation and itching of the eruption are partial 
causes of the fever, and produce much unrest and nervous irritability. 
The condition of the skin is, therefore, to be looked after, and the 
pitting prevented by every means in our power, particularly on the 
face. One of the means commonly employed is the use of flexible 
collodion, and another application is glycerite of starch or simple 
cerate applied in a heavy coating. Some physicians recommend in- 
serting the tip of a nitrate of silver stick into each vesicle as it rup- 
tures, to prevent pitting. Sometimes anointing the entire body 
with sweet oil, slightly carbolized (1 to 100), is useful to check irri- 
tation. 

If the mouth is sore a mouth-wash of chlorate of potassium and 
water may be used, flavored with a little tincture of myrrh. 

Disinfection, good ventilation, and the avoidance of much light 
are necessary. 



STINGS AND BITES. 

The stings of nearly all small animals depend for their activity 
upon formic acid, and are to be relieved by the use of dilute alkaline 
liquids, or, better still, by the application of ammonia, or, instead, 
an application of ordinary or flexible collodion may be made, which 
is improved in its action by the addition of 1 part of mercury bichlo- 
ride to 1000 of the collodion, or, if preferred, salicylic acid may be 
added in the proportion of 5 grains to the ounce. Sometimes a 
solution of carbolic acid, 1 to 100 or 1 to 50, when sponged over 
the parts exposed, not only relieves the itching of mosquito bites, 
but keeps away the mosquitoes. In other instances the stings are 
relieved and cooled by the use of dilute or pure vinegar. 

In snake-bite the best treatment is that introduced by Weir 
Mitchell and Reichert, namely, the local application of permanga- 
nate of potassium to the part, which should be thoroughly filled with 
the drug, and full doses given hypodermically about the wound, di- 
luted three-fourths with water, and followed by full doses of alcohol 
internally. 

The secret of success consists, however, in the use of a ligature or 
a cleansing of the wound as soon after its reception as possible, 
thereby preventing the absorption of the poison. 



SUNSTROKE. 551 



STYES. 

Styes consist in a localized inflammation of one of the glands in 
the margin of the lid or the surrounding connective tissue. Before 
suppuration is established abortive treatment may be practised by an 
inunction with a salve of the red or yellow oxide of mercury (grs. 8, 
5j), by painting the surface with an ethereal solution of collodion, 
or, according to Abadie, by the application of a saturated solution ot 
boric acid. Pain may be alleviated with hot compresses (water 110° 
F.), frequently changed, and as soon as pus appears incision is nec- 
essary. Associated conjunctivitis requires a boric acid solution for 
its relief. It should be remembered that styes indicate ill health, 
that tonics are indicated, and that they most frequently appear in the 
subjects of refraction error. They tend to come in crops, and the 
internal use of sulphide of calcium has been recommended. 



SUNSTROKE. 

Sunstroke, or, more correctly speaking, heat-stroke, is an affection 
produced by exposure of the body to any form of high temperature, 
whether the source of heat be the sun, a furnace, or the radiation ol 
heat from the earth. For this reason the condition may occur at 
midnight or midday. 

Heat-stroke is to be divided into two classes, in one of which exces- 
sive exposure to heat upsets the balance of the thermal mechanism ot 
the body so that fever comes on (thermic fever), in the other the 
temperature is lowered, and forms the condition known as heat 
exhaustion. 

The condition of thermic fever is much the more common of the 
two, heat-exhaustion being rare. 

The danger of thermic fever is that the excessive heat may cause 
coagulation of the myosin in the heart-muscle and of the protoplasm 
in the brain, and cause death, or that the same result may be reached 
by paralysis of respiration. 

The danger of heat-exhaustion is that death may ensue from col- 
lapse due to a general failure of vital power and the chilling of the 
body. In heat-exhaustion, too, the vascular system is greatly 
relaxed and depressed, and the circulation is at its lowest ebb. 

The treatment of these two states is, of course, radically different. 
When a patient has thermic fever, and is brought under the care 
of the physician, the first thing to be done is to loosen the clothing — 
if possible, remove it — at the same time applying cold to the body, 
and particularly to the abdomen, back, and chest. Better still, he 
may be stripped, laid upon a bed, covered with a rubber blanket, and 



552 DISEASES. 

ice-water applied by means of a sponge, or a piece of ice laid on the 
belly, while another piece is rubbed over the rest of the body. 

Care should be taken that the temperature, when it once begins to 
fall, does not drop suddenly below the normal and cause collapse. 
If the clinical thermometer in the mouth or rectum shows that the 
temperature has fallen to 100.5° F. or 101° F., the cold applica- 
tion should be stopped, and the patient allowed to lie on the bed only 
covered with a thin sheet. The bodily temperature must be constantly 
watched, as it will probably bound up again in a few minutes, and 
require the application of more cold used with the same care. This 
second rise is due either to the disorder of the nervous mechanism of 
heat production and dissipation, or to the fact that, while the surface 
of the body is cooled by the ice, the innermost viscera are still in 
high fever and rapidly heat the surface as soon as the ice is taken 
away. Antipyretics have been found to be almost useless in the 
hyperpyrexia of sunstroke, and, to say the least, are not to be relied 
upon. After the fever has been reduced permanently, the danger is 
not all passed, and it is the greatest mistake to discharge a patient as 
cured at this time. After two or three days it is very common for a 
condition of meningitis to develop, accompanied, it may be, by little 
or no fever, but characterized by violent darting headache, which is 
made worse on lying down or on sudden movement. The treatment 
of this state must be bold, and venesection is the only safe method of 
obtaining relief, although vascular sedatives, such as veratrum 
viride, may be employed. The bleeding should be enough to impress 
the circulatory system to some degree, and may be done by using 
any of the prominent veins in the arm. Sometimes a violent attack 
of epistaxis saves the man's life, when it would have been lost 
through the ignorance of his attendant, for even if life is preserved 
without vascular depression, secondary changes in the brain may 
ensue and produce hemianopsia, optic atrophy, imbecility, or insanity. 
Quinine, salicylic acid, and similar substances, are all contra-indi- 
cated because of the congestion of the meninges to which they pre- 
dispose by their physiological effects. 

The treatment of heat exhaustion consists in the use of heat instead 
of cold, in order to restore the bodily temperature. Just here, how- 
ever, must be uttered a word of warning, namely, that the mere fact 
that the skin is cold does not prove the case one of heat-exhaustion, 
since a rectal thermometer may show the central or real temperature 
of the body to be really in hyperpyrexia. Of course, such a case 
should not receive heat, but cold injections, if the symptoms require it. 

The bodily heat in heat-exhaustion is to be raised by placing the 
patient in a bath at 105° to 110°, or by the use of hot bricks or 
bottles, care beiug taken that they do not burn the patient if he is 
conscious. The bodily temperature should also be watched, lest the 
other extreme of heat be reached. 

These cases are not so apt to have meningitis, but they are generally 



SYPHILIS. 553 

slow to convalesce, and require tonics for a long time. Indeed, in 
many instances, the system seems to receive a shock from which it 
takes several weeks or months to recover. 



SYPHILIS. 

In so far as the choice of drugs is concerned the treatment of 
syphilis is exceedingly simple: iodine, iodide of potassium, and mer- 
cury practically represent the only remedial agents which are well 
proven to counteract distinctly the effects of the disease. 

In regard to the method of administration, and the period of the 
disease in which any or all of these drugs can be given to the best 
advantage, there is a wide diversity of opinion. Following the 
teaching of Fournier, in this country the practice generally obtains 
of administering mercury on the appearance of the first symptoms of 
the secondary stage of syphilis ; this drug is continued for from twelve 
to eighteen months, and is then followed by a course of iodide of 
potassium continued for from six to twelve months. If, after the 
suspension of this treatment for six months, no manifestations of 
disease appear, the patient is regarded as cured. Should the disease 
again break out, the iodides are administered in increasing doses, 
supplemented by the addition of mercury if necessary. 

Against this treatment, however, there have been many and 
vigorous protests. Every syphilographer knows that the disease is 
frequently self-limited. Zeissl states that a large number of cases 
progress to spontaneous cure, and that the secondary eruption in such 
cases disappears in from two to eight months, after which time the 
patient is perfectly well, reciclivity being far less common than 
when mercury has been employed in the early stages of the disease. 
The treatment by iodides, he thinks, should be commended, chiefly 
after the expectant plan ; their effect is not so rapid as is that of mer- 
cury ; they are suitable, however, to all stages of the disease. When 
the symptoms become so urgent that it is no longer safe to depend 
upon iodides, mercurial inunctions should be employed, the dosage 
of the drug being regulated by its effect upon the symptoms, in all 
cases the minimum quantity necessary to accomplish the result being 
administered. 

We have, then, three methods of treatment proposed, each advo- 
cated by a formidable array of authorities : 

1. The expectant treatment. 

2. The treatment by iodides, followed, if necessary, by mercury. 

3. The continued treatment, beginning with mercury, and ending 
with iodide or with the combination of the two drugs. 

By the expectant treatment is implied abstinence from all medica- 
tion intended to counteract directly the syphilitic virus ; if possible 



554 DISEASES. 

the patient should lead an active, out-of-door life, the diet should be 
most carefully regulated, and the treatment should be purely symp- 
tomatic, tonics being administered when required, the sore-throat 
being combated by astringent gargles, particularly those containing 
chlorate of potassium or malic acid, together with direct local appli- 
cations, and the eruption of the exposed parts of the body being con- 
trolled by the application of heat. The objection to this treatment 
lies in the long persistence of the secondary eruption. Where the 
primary lesion is large and persistent; where the period of secondary 
incubation is less than seven weeks ; where the papular eruption is 
universal, is confluent, and is accompanied by the simultaneous ap- 
pearance of mucous patches ; where the lymphatic enlargement is 
very marked and persistent ; and where the disease attacks a depraved 
constitution, the expectant plan offers little hope of accomplishing a 
cure. Here the second and third methods of treatment are clearly 
indicated. 

By the second plan of treatment the iodides are administered, not 
immediately on the appearance of the secondary eruption, but after 
this has run a course of several weeks, and is steadily increasing in 
severity. The iodide of potassium is chosen by preference, begin- 
ning with the administration of 5 grains, three times a day, and in- 
creasing steadily 5 grains a day until either the constitutional effects 
of the drug are manifested or the symptoms are favorably influenced. 
Should iodism appear the dose is cut down one-half, and continued 
for one or two weeks, after which, if the syphilitic lesions are not 
favorably modified, inunctions of mercury are employed, a drachm 
of mercurial ointment being rubbed in every other day. The iodide 
should be continued for from six to twelve months after the disap- 
pearance of all symptoms, relapses being combated by temporarily 
increasing the dose and by a course of mercurial inunctions ; if after 
the suspension of the treatment the patient remains free from all 
manifestations of syphilis for two years he can fairly be considered 
as cured. 

By the third method of treatment, and this is the method most 
commonly accepted in practice, the patient is placed upon mercury 
the moment the early secondary symptoms denote that the primary 
sore was surely syphilitic. Many surgeons begin this treatment 
from the time that the inguinal glands on both sides becomes charac- 
teristic in shape and size. Others wait until there is general lymph- 
atic involvement, while others believe that the mercury should not 
be administered until roseola appears. 

In regard to the particular preparations of mercury to be em- 
ployed, the protiodide, blue mass, bichloride, and the mild chloride 
represent the forms usually employed when the drug is administered 
by the stomach. Of these the protiodide is to be preferred, and the 
effort of the surgeon is directed first toward determining what has 
been termed the " tonic " dose. With this end in view, J grain of 



SYPHILIS. 555 

protiodide of mercury is given in pill form, three times a day ; every 
second day this quantity is increased by one pill, the patient being 
carefully watched in the meantime. The drug usually manifests its 
physiological effects by griping pains accompanied by two or more 
watery passages from the bowels, or by foetid breath and slight ten- 
derness of the gums. The quantity taken to produce this effect 
represents the extreme limit to which it is safe to push the drug. If 
this dose is continued or increased the characteristic symptoms of 
mercuric saturation appear. When the surgeon has determined the 
limit to which the drug can be safely pushed, this dose is cut down 
one half, and, in the absence of further complications, the patient is 
directed to continue this treatment for eighteen months. If, during 
this time, local symptoms appear, which show that the disease is not 
thoroughly under control, the mercury must again be pushed to the 
full doses, being reduced to the tonic dose as soon as the disappearance 
of specific lesions permits. Where comparatively small doses of the 
protiodide produce pain and purging opium may be added ; in this 
case the breath and the mouth will show when the full effect of the 
medicine is obtained. Manifestations of the disease occurring during 
mercuric treatment must receive local treatment. The surface erup- 
tion is combated by mercuric ointments and washes, and by the ap- 
plication of heat. Mucous patches in the mouth are quickly healed 
by applications of solid nitrate of silver or sulphate of copper, 20 
per cent, chromic acid solution, or the acid nitrate of mercury. 
When these patches occur about the genitals, washing with 1 : 2000 
bichloride solution and dusting with calomel and bismuth will be 
found satisfactory. Alopecia is combated by shampooing and by the 
application of strong stimulating lotions containing croton oil or 
tincture of cantharides. 

The intense cephalalgia is combated by -^ grain doses of calomel, 
repeated every two hours. The periostitis yields most readily to 
gentle long-continued mercuric inunction, supplemented by the appli- 
cation of pressure bandages. 

When the integrity of any vital organ is threatened there should 
be no hesitation in pushing the mercury treatment and in supple- 
menting it, if favorable results do not follow promptly, by large doses 
of iodide of potassium. 

After the first eighteen months iodide of potassium is generally 
indicated. This is commonly given together with the mercury, con- 
stituting the mixed treatment. The following formula, or one similar 
to it, may be employed : 

R. — Pot. iodid £ij to £iv. 

Hydrarg. chlor. corros. . . . . . gr. jss. 

Syrup, aurant. cort f 5j. 

Aq. . . . . . . . . q. s. f gij. 

M— S. f 3j t. i. d. 

This mixture, or iodide of potassium without the mercury, admin- 
istered in 5 to 10 grain doses three times a day, is continued for 



556 DISEASES. 

from six to twelve months longer. When the iodide is given alone 
it is most conveniently administered in the form of a saturated solu- 
tion. Of this a drop contains a grain of the salt ; milk seems to 
have the power of completely disguising the disagreeable taste of the 
drug. Thereafter, specific treatment is stopped, unless symptoms 
arise, in which case it should be renewed, and should be continued 
for many mouths. 

The protiodide is usually preferred, because the symptoms of its 
constitutional effect are manifest at first in the bowels, and because, 
in practice, it has been found one of the most satisfactory of all 
preparations. Where this form of mercury is not well borne the 
surgeon should at once employ some other salt ; the bichloride, in 
■^2 grain doses three times a day, is efficacious. Blue mass will often 
act favorably when other preparations cannot be tolerated. Its com- 
bination with iron is desirable, and the following formula represents 
one of the most valuable of the antisyphilitic pills : 

K . — Mass. hydrarg. ....... gr. xxiv. 

Pulv. ferri sesquichlor. . . . . vr. xij. 

M.— Ft. pill. No. xii. S. One t. i. d. 

Where mercury cannot be administered by the mouth it may be 
given by means of vapor baths, by inunctions, and by hypodermic 
injections. The vapor baths are useful when it is desired to 
cure promptly eruptions on the surface of the body, or when it 
is most important to bring the disease quickly under the influence of 
mercury. They are readily administered, the only apparatus required 
being an alcohol lamp, and a plate in which the mercuric preparation 
can be volatilized. The patient is seated in a chair entirely naked, 
several blankets are wrapped around his neck, and beneath the tent 
thus formed a large vessel of steaming water is placed. When the 
skin is thoroughly softened J drachm of calomel is sublimated by 
means of the lamp. These baths may be repeated every night until 
the mercuric foetor of the breath is observed, or until the specific 
symptoms disappear. 

Inunction represents the most efficient way of administering the 
mercuric treatment. When the stomach is intolerant of drugs, or 
when, administered by the mouth in full doses, they do not favorably 
modify symptoms, inunctions are indicated. Either the oleate ot 
mercury, ten per cent., or the ordiuary mercury ointment is commonly 
employed ; the former is somewhat more cleanly. The rubbings 
should be done by the patient, should be made over a large surface 
of the body, and should be done thoroughly ; 1 drachm of blue 
ointment is rubbed in daily. The patient is instructed to take a 
warm bath, the mercury is then well rubbed in over the inner surface 
of the forearm and arm, the axilla, and along the side of the chest, 
for fifteen minutes. A shirt kept for this purpose is then put on 
next to the skin and the ordinary clothing is worn over this. The 



SYPHILIS. 557 

next night the opposite arm and side of the body are utilized as the 
seat of inunction ; the next night the right groin and the inner sur- 
face of the right thigh and leg ; next, the same regions of the oppo- 
site side of the body ; finally, the anterior surface of the chest and 
abdomen. In this way irritation of the skin is avoided. Where it 
is impossible to employ the iuunctions in this way another means of 
causing absorption of mercury through the skin, suggested by Sturgis, 
will be found satisfactory. After a thorough soaking of the patient's 
feet in hot water, from J to 1 drachm of a 20 per cent, oleate of 
mercury is rubbed vigorously into the sole of one foot ; the next 
night the sole of the other foot is treated in the same way. The 
patient is directed to wear night and day a pair of woollen socks ; 
these are not changed for one week. Mercury may be taken by the 
mouth at the same time inunctions are employed, when it is desired 
to influence the system quickly. In the late periods of the disease 
very striking effects are often obtained by supplementing the iodide 
treatment by a course of twelve to eighteen inunctions. 

The hypodermic administration of mercury is. in this country, 
limited to those few cases which do not seem to respond to the drug 
when given by the mouth or by the absorbents of the skin. Al- 
though many preparations of mercury have been lauded as most 
efficacious when used hypodermically, the best formula seems to be 
that recommended by Hebra ; this consists of a solution of 1 per 
cent, of bichloride of mercury in a 6 per cent, sodium chloride 
solution ; the resulting mixture is perfectly clear and is readily pre- 
pared. If it becomes turbid it should be thrown away. Most rigid 
antiseptic precautions must be observed, as abscess formation is not 
uncommon. One injection is given daily, from -^ to J grain of the 
sublimate being administered. The nates are selected as the seat of 
the injection, the solution being driven well into the muscles of each 
side every other day. Twenty injections are usually sufficient to 
cause the disappearance of all symptoms. The employment of the 
insoluble preparations of mercury, particularly of calomel, gives 
much pain, frequently causes abscess, and is, at times, attended by a 
continuous absorption, which may produce severe and even fatal 
ptyalism. 

The ulcerations often found as tertiary manifestations of disease are 
treated according to general surgical principles. The local application 
of mercuric preparations is of less service than in the secondary lesions. 
Iodoform is peculiarly serviceable. 

The tonic and general treatment of s} 7 philitic cases must not be 
forgotten, fresh air, exercise, bathing, careful diet, reuglar living, all 
must be enjoined. Moreover, in certain cases where there is marked 
anaemia or physical weakness, cod-liver oil, stimulants in moderation, 
compound syrup of hypophosphites, aud other tonic and nutritive 
courses of treatment must receive careful attention. 

Although the treatment of an ordinary case of syphilis is simple 



558 DISEASES. 

and is satisfactory in its results, it must be remembered that there 
are malignant forms of the disease, attacking by preference feeble and 
cachectic individuals, running a rapid and virulent course unchecked, 
nay aggravated, by specific treatment, and responding feebly, if at 
all, to the most careful hygienic and tonic regimen. 



TETANUS. 

The treatment of tetanus is quite independent of its causation so 
far at least as drugs are concerned, and it is virtually identical with 
that of strychnine poisoning, to which the reader is referred. (See 
Nux Vomica, p. 229.) 



TUBERCULOSIS. 

Under this head will be considered pulmonary tuberculosis as a 
type of all forms of this morbid process. Its treatment may be 
placed in two lines — the first devoted to the cure of the disposition 
or inclination toward the disease, or the abortion of its early stages ; 
the second directed to the improvement of the patient's condition, so 
that his progress through the disease may be made as comfortable as 
possible. Before doing this, however, it is proper to state that 
prophylaxis, or true prevention, is the best object to be sought after. 
Recent studies have shown most conclusively that tuberculosis is 
capable of being transmitted from man to man or from husband to 
wife, if the air laden with bacilli is breathed, and the lungs are in a 
fit state of depressed vitality, from any cause, to afford a favorable 
field for the growth of the germ and the development of its poison. 

Cases of pulmonary consumption follow, rudely speaking, three 
well-defined lines. A very early stage sometimes comes to the care ot 
the physician, and it is that in which the following history is given 
or a similar story is elicited. A patient, previously strong and well, 
or of poor health as the case may be, begins to lose vivacity. Life 
becomes a burden and exercise is distasteful. A slight daily morn- 
ing or evening chill and fever develop, and the physician who has 
been careless treats the case as one of mild malarial poisoning. 
Examination, however, will show an area somewhere in the lung, 
generally near the apex on either one or both sides, where slight 
prolongation of expiration with a harsh inspiratory sound is heard, 
and where percussion will give impaired resonance or dulness. In 
other words, the first stage of phthisis is present, and the physician 
may resort at once to active measures for the patient's relief, which 
will be considered in a moment. 

In another form a chill, a sweat, a sudden loss of flesh and vigor, 



TUBERCULOSIS. 559 

with, more prominent than all, a hard cough, sudden in its onset 
and rapidly becoming excessive with profuse expectoration are the 
dominant symptoms. The wasting is extraordinary, the sweats are 
constant, and death may come in one or two weeks. This is the 
form known as "galloping consumption." 

The third variety is ushered in by a gradual loss of vigor or a 
sensation of being a little unwell, or is brought before the patient's 
mind by a sudden acute hemorrhage or several rapidly succeeding 
hemorrhages. This variety drags out its course more or less 
rapidly. Sometimes death soon ensues from a fatal haemorrhage, in 
other cases it keeps on for months and the case dies from wasting. 

Last of all, the fourth class is made up of persons who gradually 
pass from bad to worse. First they " catch a cold," which hangs 
on longer than it ought to, and, as soon as they are well, this is fol- 
lowed by another one which is harder to cure, until finally there is 
always a cough. Soon wasting comes on gradually, strength is lost, 
and a long period of months or years ensues during which the pro- 
gress of the case is now slow, now fast, now better, now worse, until 
death ensues from wasting, or pneumonia, or some other complication. 

These forms and stages have been roughly outlined so that a dis- 
cussion of their treatment might be taken up with a clear idea of 
what is to be done. 

When a patient exhibits the physical signs given as evidences of 
the early beginnings of phthisis, the physician should institute cer- 
tain hygienic and medicinal measures. If the individual be earn- 
ing a livelihood by following some confining occupation, this occu- 
pation must be given up and one undertaken which is carried out in 
the open air and yet not accompanied by too great exposure. Even 
if exposure is incurred it may be better than the occupation already 
followed. Thus if the patient be a bookkeeper, a printer, or a book- 
binder, or a clerk kept much at a desk in an ill-ventilated room a 
few wettings in the rain, if properly treated by the wearing of flannel 
shirts which when wet are changed as soon as labor ceases, will do 
little or no harm, the danger of catching cold being at a minimum. 
If the case is wealthy enough to be able to obtain a change of climate 
and to stop all labor, only taking exercise for pleasure or health, 
this change is, of course, of value. Some of these patients do better 
in a high, dry air and others in a lower and more moist atmosphere, 
the first being represented by that of Colorado and Saranac Lake 
in the Adirondacks, the second by that of Florida. 

In the majority of cases, however, some more moderate, or half 
and half, climate is useful, and this can be obtained in Lower Cali- 
fornia, as at San Diego, a place where they virtually have perpetual 
summer. In other words, such a spot is one where a patient can 
remain the year around, and, if well enough, engage in business, 
avoiding the cold, sharp March winds of the Middle, Eastern, or 



560 DISEASES. 

Western States, and the necessity of leaving Florida on the advent of 
summer. 

Physiciaus have attempted for years to formulate rules for phthis- 
ical patients as to the climate to be sought. In the majority of cases 
the various health-resorts have to be chosen by experiment, not by 
judgment beforehand. It is probably true, however, that high alti- 
tudes, and rarefied air, are not to be sought where a distinct tendency 
to haemorrhage is present, unless the ascent or removal to the rarefied 
air is very gradual, several weeks being passed before the lung is 
exposed to the low pressure of great heights. 

The following excellent and concise advice, given by the author's 
friend, Dr. W. Hale White, in his book on General Therapeutics? 
is so worthy of repetition that it is here given. He says : " It is of 
such importance that only suitable cases should be sent to high alti- 
tudes, that we must point out those that are unsuitable : 

" 1. Those in whom there is considerable affection of the bronchial 
tubes; for the dryness of the climate increases the kind of bronchitis 
which commonly accompanies phthisis. 

" 2. Patients with much emphysema or bronchiectasis; because of 
the probably diminished absorption of oxygen, and the difficulty of 
respiration experienced on first arriving. 

"3. Patients with disease of the heart must not go to a high alti- 
tude, because of its effect upon the pulse and upon respiration. 

" 4. Cases liable to acute febrile attacks, whether or not these 
indicate an occasional increase of mischief in the lungs, should 
remain on a low level. 

u 5. Patients who are very excitable, or suffer from insomnia, 
should not go, for a visit to a place at a great elevation promotes 
these symptoms. Women do not acclimatize so well as men. 

" 6. Cases in which there are very extensive lesions, or which are 
very advanced, are unsuitable. 

" 7. Pneumonic phthisis, if at all acute, is made worse by a high 
altitude. 

" 8. Patients who cannot take exercise should not go. 

" 9. The very old and the very young had better be treated at 
home. 

" 10. Sir Andrew Clark (London Lancet, January 5, 1889) states 
that patients who go to Alpine health resorts suffering from albu- 
minuria, or those who develop it whilst there, seldom derive any 
good from their change." 

" There are many conditions which have been thought to contra- 
indicate this treatment, but which do not, and they had, therefore, 
better be mentioned. They are : 

" Pulmonary Haemorrhage. — It is now known that this, so far from 
being a coutra-indication to treatment by high altitudes, is actually 
relieved by it. The exact explanation cannot be given." 

1 A Text-book of General Therapeutics. Macmillan & Co., London, 1889. 



TUBERCULOSIS. 561 

With this the author of this book cannot agree. 

"Fever. — If this is not excessive, and if it does not indicate any 
active changes in the lungs, it is often improved. 

"Simple Diarrhoea and Simple Dyspepsia. — These are both bene- 
fited. 

" Night-sweats. — There is a common belief that these forbid this 
treatment; on the contrary, they often disappear on removal to a 
high altitude. 

" The presence of Cavities. — This is not a contra-indication, unless 
a very large area of lung is destroyed. 

" There is no need, after these two lists, to say what cases are suit- 
able for this climatic treatment ; it may, however, be observed that 
those in which there is threatened phthisis, w T ith a strong hereditary 
predisposition, and those of imperfect thoracic development, are 
much benefited. According to most authorities, it cannot be too 
strongly urged that, so long as the condition and disease of the 
patient allow the reverse indications to be neglected, a mountain 
climate should be tried.' 7 

To these rules the author would add the following invariable 
rule, viz., Do not send a case away to die. If the disease is so far 
advanced that no good can be derived from a trip abroad, it is cruel 
to make a wretched patient exhaust his strength, his money, and his 
happiness by seeking health which it is impossible for him to obtain. 
A patient of the writer's returned on one occasion from a stay of a 
few days at a noted Southern resort for consumptives, and, when 
reprimanded for his imprudence, replied : " Doctor, I would rather 
be at home, and die at once, than drag out a few more years sur- 
rounded by a crowd of coughing, hawking, and wasting consump- 
tives." This reply evidences clearly the necessity of avoiding " con- 
sumptive resorts " as much as possible in these cases, and in directing 
the mind of the patient from depressing thoughts and his own ail- 
ment. 

The medicinal measures to be carried out in all cases of phthisis, 
except that known as the galloping form, are not numerous if we 
confine ourselves to the modes possessing any real value. For many 
years cod-liver oil has been sadly abused in the management of these 
cases and has been given at all stages, out of ignorance as a general 
rule. The writer believes that the following rules are never to be 
departed from : 

1. Never use cod-liver oil where the disease has passed the primary 
stages of thickening of the lung and roughening of the respiratory sounds, 
unless fibroid changes go on, and the changes are very slow indeed. 

2. The use of cod-liver oil when rapid degenerative changes are oc- 
curring in the lung is distinctly harmful, as it is not of any service, 
disorders the digestion and destroys the appetite. 

When the oil is used it should be given as directed in the article 
on Cod-liver Oil. 

36 



562 DISEASES. 

A remedy of equal value as a curative and of great value as a 
palliative is creasote, first introduced by Bouchard some thirteen 
years ago, but only recently widely employed. Many cures have 
been claimed from its use in the early stages of phthisis and it has 
been highly lauded by a number of European clinicians. In the 
author's experience it is merely a palliative to the cough and general 
discomfort, at least after the disease is really established, and the 
opinion expressed by Striimpel expresses so well the thought which 
the author was about to write when he read Striimpel's article that 
his words are here given : " Taking it all in all, we find that crea- 
sote, even in large doses, has no injurious effect in tuberculosis. At 
times we notice an apparently favorable symptomatic effect. We 
failed, however, to observe any real influence excited by creasote iu 
the progress of the disease. 7 ' 

When creasote is used internally it is best to be given in the fol- 
lowing formula : 

U. — Creasote (beechwood) gtt. xxxij. tof Jj. 

Tr. gentian f^j. 

Alcohol ....... f,^j- 

Tokay or Malaga wine . . . . q. s. • f Jiv. 

M. — S. Teaspoonful in water, or wine, three times a day. 

Often a 1 drop dose three times a day may be increased to 5 drops 
in the same period with advantage, by using a little more of the 
mixture each time it is taken. Sometimes 1 or 2 drops in capsules 
are as useful as the formula just named. 

Creasote may also be inhaled in the spray from a steam atomizer 
or by means of an inspirator fitted over the nose and mouth and 
made of perforated zinc with a sponge at the edge to hold the drug. 
A very good inhalation is to wet the sponge with creasote, alcohol 
and water, each one-half, or to use the creosote alone if coughing is 
not too severe. These inhalers are very cheap, not easily broken, and 
readily worn. 1 

If the cough in phthisis is excessive, a little spirit of chloroform 
placed on the sponge of the inhaler will often relieve it, or a mixture 
of morphine and wild cherry bark may be used as follows : 

R. — Morphinae sulph. ...... gr. j to ij. 

Syr. pruni Yirg. . - . . . . f^ij. 

M. — S. Teaspoonful every three hours. 

Or the following : 

R. — Potas. cyanidi . gr. j. to ij . 

Morph. sulph gr. j. to ij. 

Syr. pruni Virg. . . . . . . i'^iij. 

M. — S. Teaspoonful every four hours. 

1 These may be obtained from H. K. Mulford & Co., of Philadelphia. 



TYPHOID FEVER. 563 

Very often during the course of phthisis localized spots of pleuritic 
inflammation arises. Without any cause the patient will remark 
" Doctor, I think I have taken a little more cold and I have a stitch 
here in the chest.*' The best treatment is to apply a small blister or 
to paint the spot with iodine. (For the treatment of Haemoptysis, see 
p. 458.) 

When the night-sweats are very violent hypodermic injections of 
atropine in the dose of fa to fa grain are useful in some cases, and 
the efficiency of this treatment may be increased by the use of an 
alum sponge-bath at bedtime. A solution of alum 10 to 20 grains 
to the ounce may be sponged over the body, or sulphuric acid may 
be added to water in the proportion of 1 drachm to the pint, and 
used in a similar way to the alum solution with a sponge. 

Sulphuric acid is often given internally in these cases with advan- 
tage. Sometimes minute amounts of pilocarpine are of service. 

Small doses of pilocarpine amounting to fa grain, given from 
one to two hours before the sweat is expected, are potent for good. 
The means by which this result is brought about are not hard to 
seek. The drug in any dose causes great stimulation of the peripheral 
ends of the nerves supplying the sweat-glands. In many instances 
we find excessive secretion dependent upon depression of function, as 
in a serous diarrhoea or a local sweating of the feet. These states 
pass away just as soon as the parts regain their normal tone through 
proper treatment. The night-sweats of phthisis are improved by 
pilocarpine because this drug in all doses stimulates the sweat-glands. 
In large doses this stimulation amounts to free diaphoresis ; but in 
the minute doses such as we name, the stimulation just balances the 
depression, and a normal tone is acquired. While it is true that 
pilocarpine and atropine are physiological antagonists, it will be 
found practically beneficial to prescribe small doses of both in such 
cases as refuse to respond to either one alone, as by their antagonism 
they prevent over-action on other parts of the body, and both act in 
harmony in so influencing the sweat-glands as to be of service to the 
patient. 

TYPHOID FEVER. 

The attempt to review the treatment of the disease known as 
typhoid fever would be absolutely impossible, owing to the very 
numerous theories and practices put forward by various clinicians. 
What is said under the general heading of Fever (see page 424), 
and under the consideration of antipyrine and acetanilide, gives a 
sufficient indication as to the treatment of the febrile movements, 
and the care of the patient beyond this point is in nearly all cases 
identical. 

Before going further, however, the writer desires to insist very 



564 DISEASES. 

strongly upon this fact, namely, that a case of typhoid fever is not 
curable in any degree. No remedy yet found, except through the 
prevention of complications, has shortened its course. We can only 
guide the patient safely to health when the storm of disease comes on, 
and cannot stop the storm. 

Not only should the facts of the last paragraph be carefully borne 
in mind, but the physician must remember that he is treating an ex- 
hausting disease. Not a disease which runs a violent course for a 
few days and strands the patient sick and weak, but convalescent, 
upon the shores of health, but one iu which, after sapping his 
strength for weeks, some sudden incurrent malady or accident may 
ensue which will speedily kill him if every possible grain of streugth 
is not preserved for the struggle. The physiciau should always put 
every case in which there is a suspicion of typhoid fever to bed at 
once and keep him there till the disease has passed or fails to 
appear. Every muscular movement made unnecessarily is a w T aste 
of force, and, in consequence a bed-pan should always be employed, 
the patient not being allowed to sit erect upon a commode. 
Remembering, too, the force consumed in difficult digestion, the 
food should be liquid, free from fat, consist solely, if not entirely, 
of milk, and during convalescence, of an egg or a little arrowroot or 
corn-starch. Not only is this recommendation practically correct at 
the bed-side, but it is well based on scientific fact, for Brieger has 
shown that typhoid bacilli do not readily reproduce themselves and 
their poisons in peptone and well-digested milk, but do so very 
actively in meat broths or jelly which has not been converted by the 
digestive juices. He has also found that these bacilli generate two 
poisons, one of which causes, when given to animals, salivation, 
paralysis, and diarrhoea, the other, violent and exhausting diarrhoea 
alone. Milk diet is, therefore, evidently better than broth diet in 
typhoid fever, and we once more are able to explain an empirical 
discovery by a scientific research. Another reason for using liquid 
foods instead of solids, beyond the difficulty of digestion, is the fact 
that the solids may irritate or perforate the ulcers in the small intes- 
tine. 

Alcohol is to be used in all stages as a stimulant, a giver of force 
to the system, and as an aid to digestion. A very large part of the 
profession believes that the mere presence of an abnormally high 
temperature contra-indicates the use of alcohol. Mere high tem- 
perature does not do so, however, and it seems probable that many 
deaths have resulted from putting into practice such a belief. 

High temperature of a sthenic type, with a full, tense, bounding 
pulse, and all signs of a disease attacking one in the full vigor of 
life, of course precludes its use ; but in the high temperature of 
advanced typhoid, with the marked asthenia often present in that 
stage, alcohol should be given constantly in large amount. Under 
these circumstances the tissues which the man can afford to lose are 



TYPHOID FEVER. 565 

gone, and much of the vital portion of his system is greatly en- 
croached upon ; the alcohol yields force to the body, is then burnt 
up to a great degree, and keeps the flagging heart pumping the tides 
of blood through the lungs and systemic circulation, when otherwise 
the very cardiac depression would produce hypostatic congestion, if 
not more widespread pulmonary consolidation. 

A no less useful and valuable result obtained by the use of alcohol in 
the early stages of exhaustive fevers is the part that it plays in aiding 
digestion. The writer has already, in another paper, defined the dif- 
ference between the influence of alcohol in the artificial digestion of 
the test-tube and that occurring in the stomach. No one doubts that 
alcohol added to a small amount of gastric juice in the test-tube, 
retards or prevents its action ; but evidence is abundant to prove that 
the ingestion of this drug into the stomach produces a very decided 
increase in the quantity of gastric juice secreted over and above that 
normally present, by its stimulating and irritant action. Aside from 
experimental evidence, every-day experience has taught the gourmand 
that alcohol, in a fairly concentrated form, enables him to digest an 
amount of food which under ordinary circumstances would remain 
unchanged in his stomach. 

Alcohol should, therefore, be used all through the ordinary ex- 
hausting fevers, for the purpose, in the first stage, of aiding diges- 
tion, and, in the later stages, of supporting the system. 

The importance of aiding the flagging powers of the stomach is 
not generally recognized ; but if one remembers the fact that, at one 
time during the course of a severe attack of typhoid, an occasion 
must come when a struggle between the few remaining grains of 
strength and the disease results on one hand in death or in recov- 
ery, its importance becomes evident. By the ingestion and diges- 
tion of more food early in the attack, a larger amount of vital force 
remains for use at the crisis, and the chances of a recovery, to say 
the least, are increased. 

In those cases with a temporary loss of heart power due to 
haemorrhage or some sudden severe depression, alcohol is, above all 
others, the remedy to be employed, hot and concentrated. The 
same conditions make it, with ammonia, a most useful remedy in 
snake-bite ; where the fugacious action of the ammonia is followed 
by the more permanent stimulation of the alcohol. 

That alcohol may be misused and cause great harm, is of course 
known to every practitioner of medicine. So long as it reduces the 
temperature and lowers the rate of the pulse, causes a moistened 
skin and tongue, and quiets nervous twitchings, it does good, and 
only up to this point is it to be employed. If its administration is 
pushed after this, the tendency to adynamia becomes under the over- 
use of the drug, one of dynamia ; the pulse no longer soft, but in 
angry, bounding beats ; the nervous symptoms change from low, 
weak, muttering delirium, with subsultus tendinum, to wild, incohe- 



566 DISEASES. 

rent callings and strong tossings to and fro ; and by and by, when 
the influence of the alcohol begins to cease, and even before this 
time, the system has put forth the strength of days in a few hours, 
and the man is dead. 

The treatment used by the author in his wards at the St. Agnes 
Hospital give him results which the application of other methods 
failed to give, and is as follows : 

As soon as the patient enters the house he is washed or bathed 
and placed in bed and required to remain there. He is assured 
that the more quietly he lies the more mild and safe will be the 
course of his attack, and is made to use a bed-pan or urinal and 
never allowed to get up. He is also given five drops of dilute 
hydrochloric acid every four hours, or if the bowels are not active, 
nitro-muriatic acid is substituted therefor, care being taken to 
employ one, two, or three drops of the strong, freshly mixed red 
acid, according to the degree of coating of the tongue. The diet is 
strictly a milk diet, namely, a quart to a quart and a half a day with 
a little salt to flavor it, as already described in the article on Indi- 
gestion. Sometimes, if vomiting is threatened, half lime-water is 
added or the milk is peptonized. 

For the dry and sordes- covered tongue, a mouth- wash of glycerin 
and water, half and half, to which may be added a little lemon-juice, 
is used. If constipation is very obstinate and continues over two days 
an injection is employed, and if this, after being used twice, fails to 
act, a dose of calomel J grain every fifteen minutes, till a grain has 
been taken, is prescribed, and followed by half an ounce of sulphate 
of magnesia, if no movement occurs in twelve hours. 

When diarrhoea becomes troublesome, over four or five passages 
a day, the following will be found of service : 

R. — Acid, sulph. aromat. . . . . . . fgij. 

Ext. hasmatoxylon ....... giij. 

Syr. zingiberis ....... f^iij. 

M. — S. Teaspoonful every hour until relieved. 

Just so soon as any evidences of tympanites or much meteorism 
come on, turpentine is given as follows : 

R. — 01. terebinthinae f.^ij- 

Syr. acacise . . . . . . . q. s. f|jiij. 

M. — S. Teaspoonful t. d. 

At the same time it is well to employ a turpentine stupe over the 
abdomen (see page 288). Where the tympanites is excessive it may 
be relieved by an injection made up as follows : 

R.—Olei terebinthinae . f^j to ij. 

01. olivse fjiv. 

Mist, asafoetidae Oj. 

M. — S. Use as an injection. 



VOMITING. 567 

In the latter stages of typhoid fever, as convalescence is approached, 
turpentine is invaluable, as it causes rapid healing of the ulcers and 
stops diarrhoea, as well as prevents relapses through the absorption 
of poisonous materials from the unhealed intestinal lesions. 

For many days after the patient begs hard for more solid food it 
should not be allowed, for he will ask for it long before he should 
have it. 

The complications of typhoid fever of the most serious import are 
haemorrhage from the bowel, pneumonia and pleurisy, and perfora- 
tion of the gut. 

The haemorrhage from the bowel may be treated as indicated 
under that heading, on page 459, and the pneumonia or pleurisy be 
treated as are those diseases when free from complications (see pages 
508 and 509) ; but it is to be remembered that this is an asthenic or 
adynamic case which must not be bled or depressed, but stimulated. 
When perforation of the intestine appears, large doses of morphine 
should be given to relieve pain, put aside collapse, and allay 
irritation. Warm applications should be used over the belly and 
down the limbs, and stimulants given, if needed in those cases. 

Probably, in the future, surgery will add another triumph to the 
art by devising some fairly safe plan of operative interference for 
this state, which, if left alone, is almost always fatal. 



VOMITING. 

Vomiting is, of course, a symptom, not a disease, and arises from 
a large number of causes, some of which are very unimportant, others 
very serious. The most common cause is probably lack of proper 
digestion, with all that name implies — that is, gastro-intestinal irri- 
tation and perversion of normal function. Additional causes are 
cerebral haemorrhage, tubercular meningitis, cerebritis, or uraemia, 
which irritates the vomiting centre, or diseases of the middle lobe of 
the cerebellum, or vertigo, which is probably largely dependent upon 
disease of this lobe or the nerve-fibres going to it. 

These may all be considered as lesions of centric character which 
directly or indirectly cause the vomiting centre to send out impulses. 
On the other hand, it is worthy of note that, under certain circum- 
stances, vomiting may be reflex and dependent upon irritation of the 
nerves of the stomach or elsewhere, which convey impulses to the 
muscles whose activity results in vomiting. These considerations 
are well represented by the vomiting which comes on in incarcerated 
hernia, or in pregnancy, or in that occurring during the passage of 
renal or hepatic calculi, or in indigestion. The first variety named 
is centric, the second reflex or peripheral. 

It is important to bear in mind that peripheral vomiting due to 



568 DISEASES. 

irritability of the gastric walls may be dependent upon two condi- 
tions. The mucous membrane and its nerves may be over-excitable, 
or they may be depressed. For this reason we shall find two modes 
of treatment are necessary when this subject is considered below. 

The mechanism of vomiting consists in the closure of the pyloric 
sphincter, the contraction of the gastric muscles from the pylorus to 
the cardia, and at the same time, and more important, the contraction 
of the supplementary respiratory and abdominal muscles so compress 
the stomach as to drive out its contents through the open oesophagus. 
The violence of the muscular contractions in the abdominal walls is 
greater where the stomach is partly empty, and gives rise to that 
pain and exhaustion accompanying the conditiion known as retching. 
The practical point to be learned from this is that vomiting is always 
easier when the stomach is full; so, if an emetic is given, a large 
amount of liquid should at once follow it, if possible. Dogs vomit 
easily because of the development of the gastric muscles, but they 
make it easier yet by filling the stomach with air by swallowiug first, 
and so completely fill the viscus that its walls can contract on a 
resisting mass. 

Having described the mode and causes of vomiting, it still remains 
to consider its treatment. 

It is needless to remark that the vomiting of cerebral disease is 
very intractable, and that very active agents must be used to put it 
aside. It is probable that the vomiting following etherization is 
centric, and should be treated as should all forms of obstinate emesis, 
by the injection into the rectum of 40 grains of sodium or potassium 
bromide and 20 drops of laudanum in half a pint of water. 

By this means the vomiting ceases ; and, if it does not, may be 
made to do so, unless the cause is very serious, by a second injection 
one hour after the first. 

When vomiting seems to be due to hyper-excitability of the gastric 
mucous membrane, so that when very small amounts of food are swal- 
lowed they are at once rejected, local anaesthetics and depressants are 
needed, the chief of these being cocaine and aconite. 

Both of these drugs have disadvantages, because in effective dose 
their general physiological action may be very severe and almost 
poison the patient. When given to act as anti-emetics, these drugs do 
so by acting as local anaesthetics by paralyzing the peripheral sen- 
sory nerves. Cocaine should be given in the dose of 2 to 3 drops, in 
water, of a 4 per cent, solution every fifteen minutes until ten drops 
are taken. The aconite should be used in the form of the tincture, 
the patient being placed flat on the back, so as to withstand the 
ensuing cardiac depression with the least inconvenience, and 2 to 5 
drops of the drug given in a little water every thirty minutes till the 
rapidly weakening pulse forbids its further use. This may be 
resorted to in all forms of vomiting due to irritability of the stomach, 



VOMITING. 569 

but is contra-indicated in cases of debility or weakness. Aconite is 
generally to be preferred to cocaine. 

Sometimes a prescription of the following character is of service, 
the bismuth acting as a coating to the walls of the stomach and pro- 
tecting them : 

R. — Bismuth, subnitrat. . . • . . gij. 

Tr. aconit. . . . . . . . gr. xx to xxx. 

M. — Ft. in chart No. x. S. One powder every half hour. 

This prescription is very useful if the vomiting be due to acidity 
of fermentation and becomes excessive. 

In other cases of the same type the following is useful and may 
be preferred, if, owing to active fermentation, the vomiting is ex- 
cessive (the creasote or carbolic acid being a local anaesthetic and 
antiseptic) : . 

R. — Acid, carbolic, or creasote (Beech wood) . . gtt. x to xx. 
Bismuth, subnit. ...... gij. 

M. — Ft. in chart ISTo. x. S. One powder every hour. 

Sometimes pure chloroform in 1 or 2 drop doses, in a little water, 
does good ; and dilute hydrocyanic acid, in the dose of 2 to 6 drops, 
is also of value in like instances, given in a tablespoonful of water. 

The care of a case of vomiting dependent rather upon depression 
and debility of the stomach than upon irritation, is directed to the 
administration of gastric and it may be systemic stimulants. The 
chief one of these is ipecac in small doses, and it is this instance of 
using a drug generally resorted to for the production of emesis by 
physicians, which has caused homoeopaths to claim that we practise 
the law of similia similibus curantur and infinitestimal doses. The 
claim only holds good on its face, for we do not use an infinitesimal 
dose, and while obeying no attempt at a law use common sense. 
Ipecac is an irritant, even to the skin, and it is partly by its irritant 
effects that it causes vomiting by exciting the stomach to a point 
over and above its normal condition. In vomiting depending upon 
gastric debility and depression small doses of ipecac do good, be- 
cause they irritate the stomach sufficiently to restore its normal tone 
without going to the other extreme of hyper-excitation. Under 
these circumstances drop doses of the wine of ipecac or \ of a grain 
of the powdered ipecac every hour is of the greatest value, succeeding 
after all remedies have failed. 

In other instances tincture of nux vomica, given in J to 1 drop 
doses, is useful, as follows : 

R. — Tr. nuc. vom . gtt. iv to viij. 

Aq. cinnamom. . . . . . . f|j. 

M. — S. Teaspoonful every half hour or hoar. 

In the nausea and vomiting following an alcoholic debauch J to 1 
drop of Fowler's solution every two hours, or before food, is often 



570 DISEASES. 

capable of giving relief, and it may be used in other cases in place 
of the dux vomica and ipecac. Another useful measure in alcoholic 
nausea is the use of full doses of hydrochloric acid, 5, 10, or 15 
drops of the dilute acid in half a tumblerful of water, repeated every 
two hours. 

In all cases of vomiting counter-irritation should be applied over 
the stomach in the form of a mustard plaster, or, if preferred, an ice- 
bag may be applied to the nape of the neck, the lumbar spine, or the 
epigastrium. 

The food given in cases of vomiting should be especially prepared. 
It is best always to use peptonized milk made by using the pepton- 
izing materials sold by all the large drug firms of reliability. (See 
article on Diet, p. 328.) Lime-water should always be put in the 
milk if it is not peptonized ; the proportions usually employed are 
perfectly useless because of their smallness — at least 2 or Stable- 
spoonfuls should be placed in each glass of milk. 

Another point of importance is the quantity of liquid taken. As 
fast as the patient vomits he is often fed by well-meaning friends 
with glasses full of liquid. Properly he should have only 1 or 2 
teaspoonfuls of milk every hour, half hour, or fifteen minutes, if the 
stomach will contain it, for it is better for him to retain a drachm 
than to take a quart and vomit it. 

Where vomiting is absolutely incoercible, enemata previously 
partly digested must be resorted to. 



WHOOPING-COUGH. 

The remedies recommended for this disease are almost as numer- 
ous as the members of the medical profession, and every one of them 
is worthless in so far as a cure is concerned. Probably the very best 
drug of all in the majority of cases is antipyrine. Given in the dose 
of J to 3 grains every five hours according to the age of the child it 
will nearly always decrease the number of paroxysms but not neces- 
sarily the severity of each individual attack. 

Where the child will submit to it there is little doubt that quinine 
in a very fine spray will be of service in many cases, and it is very 
useful, when so used, as a prophylatic in other children of the same 
family who it is feared will be attacked by the same disease. The 
strength of the solution to be employed should be about 1 grain to 
the ounce of water. 

A very useful remedy in some cases is belladonna in the form of 
the tincture, in the dose of J drop twice a day to a child one or two 
years. Where great vascular engorgement ensues upon a severe 
coughing spell, vascular sedatives are of service. That is, in those 
cases in which haemorrhages from the nose, ears and mouth take 



WORMS. 571 

place veratrum viride or aconite may be used. The reason of this 
lies in the following facts : The vascular tension consequent upon 
the obstruction of respiration causes a rise of blood pressure from 
asphyxia, and the haemorrhage or the conjunctival ecchymoses named 
are due to rupture of the small bloodvessels under the strain. By 
lowering vascular tension we prevent so great a spasm of the blood- 
vessels and avoid vascular rupture or distention. 

Where paroxysms come on so rapidly as really to interfere 
seriously with respiration a whiff of chloroform poured over the 
parent's hand may relax the spasm and in other instances nitrite of 
aniyl is equally serviceable and more safe. 

The vomiting following the cough may be overcome by using 
such minute amounts of milk as to enable nutrition to go on without 
at any time overloading the stomach, as, for example, a teaspoonful 
after each paroxysm of cough. 



WORMS. 

Intestinal parasites are commonly represented by the Ascaris 
Lumbricoides, or round-worm ; Taenia Solium, Taenia Media Canel- 
lata ; and the Bothriocephalus Latus or tape- worms ; and finally, by 
the Oxyuris Vermicularis, sometimes called seat-, pin-, or thread- 
worms. 

The round-worm and tape-worm are to be attacked by way of the 
patient's mouth, the seat-worms by the anal opening, ; and before 
mentioning the drugs to be employed it is necessary to insist upon 
one or two important points, disregard of which will result in failure 
in treatment. 

Whenever a round- or tape- worm is to be attacked the patient must 
be starved for at least twelve to twenty-four hours, in order that no 
food in the intestinal tract may protect the worm from the action of 
the drug. During this time a little milk may be taken, and after a 
night of fasting, before breakfast, the anthelmintic must be swallowed. 
Further than this, nearly all of these drugs must be followed by 
purges in order to dislodge the intruder while he is paralyzed and 
has lost his hold, and in many instances it is well to have a basin of 
salt and water ready so that when a passage occurs an injection may 
follow and wash out any remaining segments of the worm which may 
remain behind in the rectum. 

In the treatment of thread-worms it is necessary to wash out the 
bowel thoroughly with soap and water to dislodge the faecal matter 
and expose the worms in the folds of the mucous membrane. 

The drugs which are used against the round- worm are : spigelia in 
the form of the fluid extract, dose 1 drachm to a child of two or three 
years, or 2 drachms to an adult ; or better still, the fluid extract of 



572 DISEASES. 

spigelia and senna, dose 2 to 3 drachms, given in divided does to a 
child. Oil of chenopodium, dose 5 to 20 drops on sugar. Santonin, 
dose J- to J .grain to a child in the form of troche, made by using the 
crystals, or as much as 2 to 4 grains to an adult. (See Santonin.) 

Brayera, or kooso, is given also for the same worm in the form of 
the infusion, made by adding J ounce of the powdered leaves to 1 
pint of water and mucilage of acacia, half and half of each, and 
drinking the mixture, or in the form of the fluid extract, in the dose 
of \ ounce to an adult. Koosin may be given in 40 grain doses in 
capsule to adults, but it should not be used against worms in preg- 
nant women, as it may cause abortion. 

Unless the spigelia is used with senna it should always be followed 
after two or four hours by a full dose of castor oil or a saline purga- 
tive to sweep out the worm, and the same rule holds true of all the 
other drugs mentioned above. 

The most efficient remedy against the tape-worm is pelletierine, 
the active principle of pomegranate, dose 20 grains in capsules ; or 
pepo or pumpkin seed (2 ounces) may be resorted to when deprived 
of their outer coating and rubbed into a paste with sugar. Almost, 
if not quite as valuable a remedy is male fern, or Jilix mas, or as it is 
officinally called, Aspidium. Used in the form of the oleoresin 
( Oleoresina Aspidii) in the dose of J to 1 drachm to an adult, it should 
be followed in three or four hours by a calomel purge, aided by a 
saline. The calomel or the bile which is present is peculiarly 
abhorrent apparently to the tape-worm, and its free secretion should 
follow all the drugs just named. 

By far the most useful remedy for seat-worms is quassia by injec- 
tion. . One to two ounces of powdered quassia or quassia chips may 
be made into a decoction with a pint of water, and half of this injected 
into the rectum after it is well cleansed with soap and water. The 
quassia injection should be held for some minutes, and in children this 
may be accomplished by pressing upon the anal opening a towel 
covering the ball of the thumb. If this fails to bring away all the 
worms in three or four trials, either there are none present or the 
bowel is not washed properly. 



TABLE OF DOSES OF REMEDIES. 



Remedies. 


Dose. 


liEMEDIES, 


Dose. 


Abstract, aconiti 


• i 


to i g. 


Aconitina (white 




aspidospermae 


. 5 


« 20 " 


crystals) . . . 


¥0-0 t0 270 g- 

- *" 


belladonnae . 


• i 


" n u 


Adonidin . . . . 


cannab. ind. 


. l 


" 3 " 


Agaricin . . . . 


1 ii 4 ii 


conii . . . 


. l 


« 2 » 


Aloe 


2 " 5 " 


digitalis . . 


. l 


" 3 " 


Aloinum . . . . 


1 ii 3 ii 


gelsemii . 


. l 


« 3 u 


Alumen 


10 " 15 " 


hyoscyami . 


. 2 


u 5 u 


Ammonii benzoas 


10 " 20 " 


ignatiae . . 


. 1 


" 3 " 


broraid 


5 " 30 " 


ipecac . . . 


• 3 


" 30 " 


carb 


3 " 10 " 


jalapae . . 


. 6 


ii io «* 


chlorid 


10 " 30 " 


nuc. vom. 


• i 


i. in 


iodid 


3 " 15 " 


phytolaccae . 


. 5 


ii 15 ii 


phospb 


5 " 20 " 


pilocarpi . . 


. 6 


» 30 " 


picras 


i" i tl 


podophylii . 


. 4 


u 10 u 


sulph 


3 ({ 15 " 


senegse . . 


. 4 


II 10 " 


valer 


3 » 15 » 


Valerianae 


. 10 


n 15 II 


Amyl nitris ... . 


2 " 5 m. 


veratr. vir. . 


. 1 


ii 3 ii 


Amylum iodaturu 


3 " 30 g. 


Acetphenetidine 


. 1 


« 2 " 


Antifebrin . . . 


— 8 « 


Acet. lobeliae . 


. 15 


" 30 m. 


Antimonii et pot. 




opii . . . 


. 5 


ii 16 .< 


tartr.; diaph. 


l a 1 n 

20 12 


sanguinar. . 


. 15 


« 30 " 


et. pot. tartr.; emet 


c 1 " 2 " 


scillae . . . 


. 10 


« 30 " 


oxid 


1J " 2 " 


Acid. acet. dil. 


. 60 


" 90 " 


oxysulphuret . 


i ii 2 « 


arsenious . 


i 

• 64 


11 ioS- 


sulphid. . 


i " 2 " 


benzoic . . 


. 5 


ii 15 ii 


sulphuret. . . 


i ii 2 « 


boric . . . 


. 5 


ii 10 u 


Antipyrin . . . 


— " 20 «■« 


carbolic . . 


. 1 


ii 3 «i 


Apiol 


3 " 5 " 


gallic . . . 


. 3 


K 15 u 


Apomorph. hydro. 




gall.inalbumini 


iria 10 


" 60 " 


chlor 


i et i u 

"3 10 


hydrobrom.(34 


3.C.)10 


ii 15 ii 


Aqua ammonise . 


6 " 30 m. 


hydrobrom. dil. 


. 40 m. to 2 fl. d. 


Aqua amygd. amar. 


2 " 4fl. d. 


hydrochlor. . 


. 3 


" 10 m. 


camphorae. . . 


1 » 2 fl. oz 


hydrochlor. dil. 


. 10 


" 30 " 


chlori 


1 » 4fl. d. 


hydrocyan. dil. 


. 2 


n 6 u 


creasoti . . . 


1 » 4 " 


lactic . . . 


. 15 


" 60 g. 


laurocerasi . . 


6 " 30 m. 


nitr. . . . 


. 3 


" 10 m. 


Arbutin .... 


5 » 15 g. 


nitr. dil. . . 


. . 10 


« 30 " 


Argenti iodidum. 


\ " 2 " 


nitro-hydrochlo 


r. . 3 


ii 10 ii 


nitras .... 


i " +" 


nitro-hydrochlo 


r.dil. 5 


" 20 " 


oxid 


i " 2 " 


Acid, phosphoric 


(50 




Arsenii iodidum . 


i ii i » 

64" TO 


percent.) . 


. . 3 


" 15 g- 


Assafcetida . . . 


5 " 20 " 


phosphoric dil. 


. 10 


" 30 m. 


Atropina . . . 


i « i ii 

128 3 2 


salicylic . . 


. . 5 


" 20 g. 


Atropinse sulph. . 


1 il 1 (1 

1^8" ¥^ 


sulphuric . . 


. . 5 


" 10 m. 


Auri et sodii chlorid 


1 (( 1 II 
32 T6 

20 ll 30 m. 


sulphuric diJ. 


. . 5 


" 30 » 


Balsamum gurjunae 


sulphuric arom 


. . 5 


ii io " 


Belladonnae fol. . 


. 1 " 10 g. 


sulphurous . 


. . 30 


" 60 " 


Belladonna rad. . 


. 1 " 5 " 


tannic . . . 


. . 2 


« 10 g. 


Benzanilide . . 


. 1 " 6 " 



574 



TABLE OF DOSES. 



Remedies. 


Dose. 


Remedies. 


Dose. 


Berberinse sulpb 


. 3 to 10 g. 


Decoct, sarsap. com p. 


2 to 


6 fl. oz 


Berberina and its salts 3 " 15 " 


Digitalinum 


1 <( 


3"2" 6 * 


Bismuthi citras 


. . 3 " 15 « 


Digitalis 


I " 


2 " 


et amnion, cit 


r. . . 1 "15 " 


Duboisina, and its 






subcarb. . 


. . 6 " 30 " 


salts 


1 a 
TUg" 


1 tt 

6 


subnitr. . 


. . 30 " 60 " 


Elaterinum ; U. S. P. 


1 




tannas. 


. . 6 " 30 " 


1880 .... 


1 (( 
6 0" 


T3 " 


valer. . 


. . 1 " 3 " 


Elaterinum; U.S. P., 






Brayera . . . 


. . 2 " 6' d. 


1870 . . . . 


1 tt 
To 


* " 


Brucina . .- . 


■ • <r\ " tV g- 


Emetina, and salts, 






Caffeina . . . 


. . 1 " 5 " 


emetic .... 


1* <" 


i " 


Caffeinse citras . 


. . 1 " 5 " 


and salts, diaph. . 


T2U 


1 (( 

3" 


Calcii bromidur 


n . .5 " 30 " 


Emnlsio hydrocyan. 


^ " 


1 fl. d. 


carb . . . 


. . 15 " 60 " 


Ergota 


15 " 


60 g. 


hypophosphis 


. . 3 " 15 " 


Ergotinum .... 


2 " 


8 " 


iodidum . 


. . 1 " 3 " 


Eserina, and its salts 


1 a 

"6¥ 


J " 


Calcii phosphas 


. . .15 "30 » 


Extr. aconiti fol. fluid 


1 « 


5 m. 


Calx chloridun 


. . 10 " 20 " 


aconiti rad.; U.S.P. 






Calx sulphurate 


i . . i " 1 " 


1880 . . . . 


l tt 


4 g- 


Camphora . 


.- . 3' « 10 " 


aconiti [rad.] fluid 


i " 


2J m. 


Camph. monob 


rom . 2 " 5 " 


aconiti fol. (Eng.) . 


* " 


i g- 


Cantharis . . 


. . 1 " 2 " 


aconiti fol.; U.S. P., 






Capsicum . . 


. . 1 " 3 " 


1870 . . . . 


* " 


i " 


Castoreum . . 


. . 6 ■ « 15 " 


aletridis fl. . . . 


15 " 


30 " 


Catechu . . . 


. . 15 « 30 " 


alni rubrae fl. . . 


15 " 


30 {( 


Cerii nitras . . 


. . 1 » 3 " 


aloes aquos . . . 


* " 


3 g- 


oxalas . . . 


. . 1 " 3 " 


alston. constr. fl. 


1 » 


4 fl. d. 


Chinoidinum 


. . 3 " 30 « 


angelicse rad. fl. . 


30 " 


60 m. 


Chinoline . 


. . 5 " 10 " 


angusturse fl. . . 


15 " 


45 " 


Chloral . . 


. . 3 " 20 « 


anthemidis . . . 


2 » 


10 g. 


Chloroformum. 


. . 1 " 5 m. 


anthemidis fl. . . 


30 « 


60 m. 


Chrysarobinum 


. . 3 " 15 g. 


apocyni andros fl. . 


8 » 


50 " 


Cinchona 


. 15 " 60 " 


apocyni can nab. fl. 


8 " 


30 " 


Cinchonidina, 


md its 


aralise hisp. fl. . . 


30 " 


60 " 


salts . . . 


. . 1 « 30 " 


aralise nudic. fl. 


30 ' 


60 " 


Cinchonina, ai 


id its 


araliae racem. fl. . 


30 " 


60 » 


salts . . . 


. . 1 " 30 " 


aralise spin. fl. . . 


30 ' 


60 " 


Cinnamomum . 


. . 6 " 30 " 


arecese fl. . . . . 


45 ' 


75 " 


Cocaine . . . 


. . 1 " 4 p. c. sol. 


arnica? flor. . . 


3 ' 


8 g- 


Coca? fol. . . 


.. . 1 " 3 " 


arnicse fl. . . . . 


5 < 


15 m. 


Codeina . . 


• • * "■" 2 g. 


arnica? rad. . . 


2 < 


5 g- 


Colchicin 


1 it 1 a 
• 10 "S'O 


arnica? rad. fl. . 


5 ' 


15 m. 


Colocynthin 


. . i « 2 » 


aromat. fl. . . . 


30 » 


60 " 


Confectio senm 


e . . 1 " 2 " 


ari triphylli fl. . . 


15 ' 


30 " 


Coniina, and it 


s salts -g^ -g^ 


asari fl 


15 ' 


30 " 


Convallamarin 


e . . J " 4 " 


asclep. incarn. fl. . 


15 ' 


30 " 


Copa'ba . . 


. . 15 " 60 m. 


asclep. syr. fl. . . 


15 ' 


30 » 


Cota . . . 


. . 1 « 2 g. 


asclep. tuber, fl. . 


15 ' 


30 » 


Cotoina . . 


i- " A " 

6 Y 


aspidii fl 


1 ' 


4 fl. d 


Creasotum . 


. . 1 " 3 m. 


aspidosperma? fl. . 


15 ' 


45 m. 


Creta prsepar. 


. .15 " 75 g. 


auranti cort. fl. 


1 " 


2£ fl. d 


Croton chloral 


. . 1 " 5 " 


azedarach fl. . . 


15 » 


75 m. 


Cubeba . . 


. . .15 « 60 " 


baptisise fl. . . . 


7 » 


30 » 


Cupri acetas 


• • - lg- 


bellad. alcohol. 


t ' 


i g- 


sulphas . 


• • I " * " 


bellad. fol. (Eng.) . 


* ' 


1 " 


Cupri am. . 


• • t " 1 (l 


bellad. fol. fl. . . 


3 ' 


6 m. 


Curare . . 


1 it X it 
~5? 6 


bellad. rad. . . 


* ' 


' t g. 


Curarina 


1 tt 1 it 
6T 2^0 


bellad. rad. fl. . . 


1 " 


3 m. 


Daturine 


1 'CC 1 <( 

• 10 TO 


berber. aquifol. fl. . 


15 » 


30 » 


Decoct, aloes c( 


>mp. . J " 2 fl. oz. 


berber. vulg. fl. 


15 ' 


30 " 







TABLE OF DOSES. 




5 


Remedies 


Dose. 




Remedies. 


Dose. 


xtr. boldi fl. . . . 


3 


to 15 


m. 


Extr. dioscoreae fl. 


. 15 to 30 m. 


brayerae fl. . . . 


2 


" 4 


fl. d. 


ditae fl. . . 


. . 1 < 


< 4 fl. d 


bryoniae fl. . . . 


15 


" 60 


m. 


dracontii fl. . 


. . 30 


• no g. 


buchu fl 


i 


" 2£ 


fl. d. 


droserae fl. 


. . 5 


• 10 m. 


calami fl. . . . . 


15 


" 60 


m. 


dulcamarae . 


. . 5 


' 15 g. 


calend. fl 


15 


' ; 60 


it 


dulcamara? fl. 


. . 1 ' 


< 2 fl. d 


calumbae 


3 


" 10 


g- 


ergotae . . 


. . H < 


' 8 g- 


calumbae fl. . . . 


15 


'• 60 


m. 


ergotae fl. . . 


. . 15 ' 


' 60 m. 


canellte fl . . . . 


15 


" 60 


a 


eryodictyi fl. 


. . 15 


' 30 » 


cannab. Amer. fl . 


3 


'• 15 


(< 


erythroxyli fl. 


■ • i 


' 2 fl. d 


cannab. ind. . . 


i 


it 1 


g- 


eucalypti fl. . 


. . 15 ' 


< 60 m. 


cannab. ind. fl.. 


3 


' ; 6 


m. 


euonymi fl. . 


. . 15 


' 60 " 


capsici fl. . 


1 


" 3 


k 


eupatorii fl. . 


. 30 


< 60 « 


cardam comp. fl. . 


15 


" 45 


» 


euphorb. ipec. f 


I. . 5 ' 


< 30 " 


cardui bened. fl. 


15 


" 60 


" 


ferri pom. 


. . 3 < 


' 15 g. 


carnis 


15 


" 60 


ir. 


frangulae fl. . 


• * ' 


; 2£ fl. d 


cascara sagrad fl . 


10 


«< 20 


m. 


frankeniae fl. 


. 8 ' 


; 15 m. 


cascarillae fl . . . 


I 


" 2J 


fl. d. 


gallae fl. . . 


• • t ' 


' 2 fl. d 


castaneae fl . . . 


3 
4 


" 2J 


it 


gelsemii . . 


. . 2 ' 


; 8 m. 


catariae fl . . . . 


i 


" 1* 


a 


gelsemii fl. . 


. . 5 


' 20 " 


catecbu liquid . . 


8 


" 30 


m. 


gent. fl. . . 


. . 30 


' 60 u 


caulophylli fl 


15 


" 30 


n 


gent. comp. fl. 


. . 30 


' 60 " 


cbelidonii fl . . . 


15 


" 30 


" 


gent, quinque f 


. . 15 


' 30 " 


chelonis fl . . . 


30 


'■ 60 


" 


geranii fl. 


. . 15 


' 30 " 


chimaph. fl . . . 


I 


" H 


fl. d. 


gei fl. . . . 


. . 15 


' 30 " 


chionanthi fl . . 


I 


" 2£ 


a 


gilleniae fl. . 


. . 15 


' 30 " 


chirettae fl . . . 


i 


" H 


it 


gossypii fl. . 


. . 15 


' 45 " 


cimicifugae fl . . 


8 


" 30 


m. 


gran ati rad. cor 


t.fl. f 


' 2 fl. d 


cinchoniae . . . 


15 


" 30 


g- 


grind, rob. fl. 


. . 30 < 


' 60 m. 


cinchoniae fl . . . 


30 


" 60 


m. 


grind, squarr. f 


. . 30 ' 


' 60 " 


cinchoniae arom. fl. 


30 


'• 60 


" 


guaiaci ligni fl. 


. 30 < 


1 60 « 


cinchoniae comp. fl. 


i 


« n 


fl. d. 


guaranae fl. . 


. . 15 


< 30 « 


cocae 


i 


" 2 d. 


haematoxyli . 


. . 8 ' 


' 30 g. 


cocculi fl. . . 


l 


" 3 


m. 


haematoxyli fl. 


. 30 ' 


' 60 m. 


colch. rad. . . . 


I 


" 1* 


g- 


hamamelid. fl. 


. . 30 ' 


' 90 » 


colch. rad. fl. . . 


2 


a 4 


m. 


helleb. nigris 


i t 

1Z 


' 3 g. 


colch. sem. fl. . 


n 


" 6 


a 


helleb. nigris fl 


. 5 ' 


' 15 m. 


collinsoniae fl. . . 


30 


" 60 


a 


heloniae fl. 


. . 8 ( 


' 30 " 


colocynth . . . 


n 


" 5 


g- 


hepaticae fl. . 


. .30 ' 


' 60 " 


colocynth comp. . 


i§ 


" 5 


it 


humuli . . 


. . 3 ' 


' 15 g. 


condurango fl . . 


8 


" 30 


m. 


humuli fl. 


. 30 < 


' 60 m. 


conii fol. (Eng.) . 


1 


a 4 


g- 


hydrangeae fl. 


. 30 < 


' 60 " 


conii fol. ale; U.S. 








hydrastis . . 


. 3 ' 


' io g. 


P., 1870 . . . 


1 


" * 


a 


hydrastis fl. . 


. 8 ' 


: 30 m. 


conii [fr.] ale; U. 








hyoscyami (En 


sO i ' 


' 4 g. 


S. P., 1880 . . 


1 


" 1 


it 


hyoscyami ale. 


. i ' 


' 2 » 


conii fol. fl. . . . 


1 


" 2 


m. 


hyoscyami fol. J 


a. . 3 ' 


' 15 m. 


conii [fr.] fl. ; U. 








hyoscyami sem 


fl. 2 ' 


t 8 u 


S. P., 1880 . . 


1'* 


" 5 


a 


ignatiae . . 


i i 

4 


' i g- 


convallariae rad. fl. 


15 


" 30 


" 


ignatiae fl. . 


. . 1 < 


' 6 m. 


coptidis fl. . . . 


30 


" 60 


m. 


ipecac fl. . . 


. . 3 < 


; 60 " 


corn. flor. fl. . . . 


30 


" 60 


a 


iridis versicol. 


. 3 < 


' 6 g. 


corydalis fl. . . . 


15 


" 30 


a 


iridis versicol. f 


. . 15 < 


' 30 m. 


coto fl 


3 


" 15 


a 


jaborandi fl. . 


. 10 ' 


' 60 ' : 


cubebae fl. . . . 


15 


" 30 


a 


jalapse; U.S.P., 


1870 5 ' 


' io g. 


cypripedii fl. . . 


15 


" 60 


" 


jalapae ale. . 


. . 3 ' 


< 6 » 


damianae fl. . . . 


\ 


« 2£ 


fl. d. 


jalapae fl. . . 


. 15 ' 


' 30 m. 


delphinii fl. . . . 


1 


" 3 


m. 


juglandis . 


. 15 < 


' 30 g. 


digitalis . . . . 


* 


" \ 


g- 


juglandis fl. . 


3 I 
4 


' 2 fl. d. 


digitalis fl. . . . 


1 


" 6 


m. 


junip. fl. . . 


. 30 < 


' 60 m. 



575 



576 



TABLE OF DOSES. 



pulsatillae fl. 
quassiae . 
quassiae fl. 



30 to 

15 " 

5 " 

30 " 

5 " 

15 " 

8 " 

1 " 

I " 

30 " 

3 " 

30 " 

1 << 

5 " 

5 " 

1 » 

i " 

1 » 

30 " 

8 " 

30 " 

15 •< 



Remedies. Dose. 

Extr. kamala fl. 
kino, liquid 
krameriae 
krameriae fl. 
lactucae . 
lactucae fl. 
lactucarii fl. 
Iappa3 fl. . 
lands fl. . 
leonuri fl. 
leptandrae 
leptandrse fl 
lobelia? fl. 
lupuli fl . 
lycopi fl. . 
milta . . 
manzanitae fl 
marrubii fl. , 
matico fl. 
matricariae 
menispermi 
methystice fl 
mezerei . 
mezerei fl. 
micromeriae 
mitchellae fl. 
myricae fl. 
nectandrae 
nuc. vom. 
nuc. vom. fl 
nuphar fl. 
nymphaeae fl 
cenotherse fl. 
opii . . 
papaveris 
papaveris fl. 
pareirae fl. 
petroselina fl 
phellandrii fl 
phoradendri fl. 
physostigmae 
physostigmae fl 
phytolaccae baccar 
phytolaccae rad 
phytolaccae rad. fl 
pilocarpi fl. 
pimentae fl. 
piper, nig. fl 
piscidiae fl. 
podophylli 
podophylli fl 
polygoni fl. 
polygon ati fl 
populi fl. . 
prinos fl. . 
prun. virg. fl 



15 

30 
30 

1 

* 
1 
5 
5 
15 

i 

2 

15 

30 
1 
1 

i 
? 

1 

. 5 

1 

5 

15 

15 

15 

15 

i 

2 

8 

15 
5 

30 
30 
30 
15 

2 

1 

30 



60 m. 

30 » 

15 g. 

60 m. 

15 g. 

60 m. 

30 " 

2 fl. d. 

2 " 

60 m. 

10 g. 

60 m. 

5 " 

15 " 

30 " 

2£d. 

2 fl. d. 

2 » 

60 m. 

30 » 

60 " 

60 " 

1 g- 
10 m. 
60 " 
60 " 
60 " 

4 fl. d. 

i g- 

5 m. 
15 " 
15 " 
30 " 

i g. 

2 » 
45 m. 
60 " 

2 fl. d. 

2 " 



g- 



1 

* 

3 

30 
3 

30 m. 

60 " 

45 " 

45 " 

60 » 

n g. 

30 m. 

30 " 

15 " 

60 » 

60 » 

60 " 

30 " 

5 " 

5 g- 
60 m. 



Remedies. Dose. 

Extr. quebracho fl. . 20 to 60 

quercus fl. . . . 30 " 60 

rhamnicath.ft.fi.. 30 "60 

rhamnipur. cort. fl. 30 "120 

rhei 5 " 10 

rhei fl 15 " 45 

rhois arom. fl. . .15 " 60 
rhois glabr. cort fl. 30 " 60 
rhoisglabr.fruct.fi. 30 "60 
rhois toxicod. fl. . 1 " 6 
ricini fol. fl. . . . J 

rosaa fl J 

rubi fl. . . . .15 
ruraicis fl. ... 30 

rutae fl 15 

sabbatiae fl. . . .30 

sabinae fl 5 

salicis fl J 

salvise fl J 

sambuci fl. . . . J 
sanguin. fl. . . . 5 
santali citr. ... 1 
santonicae fl. . .15 
sarsap. fl. ... J 
sarsap. comp. fl. . J 
sassafras fl. . . . J 

scillae fl 5 

scillae comp. fl. . . 5 
scoparii fl. . . . J 
Scutellariae fl. . . ^ 
senecionis fl. . . 1 
senegae fl. ... 8 

sennae fl 1 

serpent, fl. . . .30 
simarubae fl. . . .15 
solidag. fl. . . . 30 
spigelian fl. . . . 15 
spigeliaeet sennae fl. J 
stillingiae fl.. . • i 
stillingiae comp. fl. J 
stramonii (Eng.) . J 
stramonii fol. ale. . § 
stramonii sem. . . £ 
stramonii fl. . . 1 
sumbul fl. . . .15 
taraxaci .... 5 
taraxaci fl. . . . J 

thujae fl 8 

toxicodendri fl. . 1 
trifol. prat. fl. . . 1 

trillii fl J 

trit. rep. fl. . . . 1 
tussilag. fl. . . .30 
urticae rad. fl. . . 5 
ustilag. maid. fl. . 15 
uvae ursi fl. . . .30 
vaccin. crassifol. fl. 30 
valerian .... 5 

valer. fl 30 

veratr. vir. fl. . . 2 



« 2 fl. 


d 


< 2 


u 




< 60 


m 




< 60 


<c 




• 30 


u 




' 60 


it 




1 15 


a 




1 2 


fl. 


d 


< 2 


(< 




< 2 


a 




4 15 


m 




' 2 


fl. 


d 


< 60 


m 




' 2 fl. 


d 


< 2 


a 




■ 2 


u 




< 30 


m 




1 30 


(t 




' 1 


fl. 


d 


« 2 


(< 




< 2 fl. 


d 


< 15 


m 




1 4 fl. 


d 


< 60 


m 




< 30 


(< 




' 60 


" 




' 60 


a 




< 2 


fl. 


d 


• 2 


a 




1 2 


" 




< 1 

< 6 


g- 
(( 

m 




' 60 


a 




« 15 g. 
' 2 fl. 


d 


' 15 


m 




' 5 


u 




1 2 fl. 


d. 


' 2 


<( 




' 4 fl. 


d 


' 60 


m 




' 15 


a 




< 60 


a 




1 60 


" 




' 60 


" 




< 15 

< 60 


g- 

m 




' 8 


u 





TABLE OF DOSES. 



577 



Remedies. 
Extr. verbenas . 

viburni opuli 

viburni[prunifol.]fl 

wahoo 

xanthoxyli cort 

xanthoxyli fruct. fl 

zingiberis fl. 
Fel bovis purif. 
Ferri arsen. . 

benzoas . 

bromid. . . 

carb. sacch. . 

chlorid. , . 



citr. 



ilph. 



et amrnon. citr 

et amnion, su 

et amnion, tartr 

et cinchonid. citr. 

et pot. tartr. . 

et quin. citr. 

et strychn. citr 

hypophosphis 

iodidum . . 

iodidum sacch. 

lactas . . . 

oxalas . . . 

oxid. magnet. 

oxid. hydrat. 

phosphas . . 

pyrophosphas 

subcarb. . . 

sulphas . . 

sulphas exsiccat 

valer. ... 
Ferrum diaiys. 

redact. . . 
Gamboge . . 
G-aultheria, oil of 
Guarana. . . 
Helloborein 
Hydrarg.chlor. corros 

chlor. mite . 

iodid. flav. . 

iodid. rubr . 

iodid. vir. . 

subsulphas flav 

c. creta . . 
Hydrastin . . 
Hyoscine 

Hyoscyamina & sa 
Hypnone . . 
Ichthyol . . 
Infusum brayerae 

digitalis . . 

sennae comp. 
Iodoformum . 
Iodol. ... 
Iodum . . . 



Its 





4 

10 

30 



To 

" 8 

.< 1 

TO 
» 1 

" * 

'"■ 8 
« 10 
i 
7o 



i 
3 

5 
Tib 



T3 8" 3 2 

— 1 



T , f expect 

Ipecacuanha j ^ 



Dose. Remedies. 

15 to 60 m. j Jalapa . . . 
fl. d. Kairin . . . 
" i Kamala . . . 

g. ! Kino .... 

m. Lactucarium . 

Lewinin. . . 
Liq. amnion, acet 
acidi arseniosi 
arsen. et hydr. iod 
ferri chloridi 
ferri diaiys. . 
ferri nitrat. . 
pepsini . . 
Liquor potassas 
potassii arsenit 
potassii citrat 
sodae . . . 
sodii arseniatis 
Lithii benzoas. 
bromid . . 
carb. . . . 
citr. . . . 
salicylas . 
Lupulinum . . 
Magnesia . . 
Magnesii carb. . 
Magnesii citr. gran 
sulphas . . 
sulphis . . 
Manganese binox 
Mangani sulphas 
Manna . . . 
Massa copaibae 
ferri carb. . 
hydrarg. . . 
Mist, ammoniaci 
asafoetidae 
chloroformi. 
creta?. . . 
ferri comp. . 
ferri et. amm. acet 
glycyrrh. comp 
magnes. et asafcet 
potassii citr. . 
rhei et sodae . 
Morphina and it salts 
Moschuol . . 
Moschus . . 
" Naphtholinum 

g. Naphthol . . 

m. Narceina . . 

g. Nitroglycerinum 

fl. oz. "Nux vomica . 
fl. d. Oleoresina aspidii 
fl. oz. capsici . . 

g. cubebae . . 

Oleoresina filicis 
lupulini . . 
piperis . . 
30 " zingiberis . 

37 



1 
. 1 

1 
15 
15 

8 

3 

2C 

1 

1 

4 
1 
5 
5 
5 
5 
5 
13 
5 
1 
5 
1 
2 
1 
1 
5 

* 
1 
1 
5 

1 

i 

2" 
1 
1 
1 
1 



2 

2 

5 

30 

30 

30 

6 

* 

5 

5 

15 

3 
10 
10 
10 
15 
10 
GO 
10 

5 
10 

5 



" 3 
« 10 
" 2 
" 5 
" 5 
" 30 
" 3 

'• 1* 

" 3 
' 15 



Dose. 

15 to 30 g. 
— 8 " 

1 " 2d. 
8 « 30 g. 
8 " 15 " 

50 per cent. sol. 

2 to 8 fl. d. 
2 " 7 m. 

2 " 7 " 

2 " 10 " 

1 '• 15 " 
8 " 15 " 

2 " 4 fl. d. 
5 '• 30 m. 

3 " 7 " 

2 " 4 fl. d. 
5 " 30 m. 

3 " 7 " 
2 « 5 g. 

1 ■«» 3 ci 

2 " 6 " 
2 " 5 " 
2 ; ' 8 " 
5 " 10 " 

15 " 60 " 

15 " 60 " 

2 " 8 d. 

2 " 8 " 

8 " 30 g. 

2 " 4 " 

2 « 10 g. 

1 " 2 oz. 

5 " 30 g. 

5 " 15 " 

1 " 15 " 

4 » 8 fl. d. 

4 " 8 " 
I " 2 " 

1 " 2 fl. oz. 

\ " 2, » 

| " 1 «« 

1 " 4 fl. d. 

1 " 4 « 

\ " 2 fl. oz. 

h " 1 " 

T6 " \ g- 

1 " 5 " 

2 " 15 " 
2 " 10 » 
2 " 5 u 

* " i g. 

1 d. of 1 p. c. sol 

1 " 5 g. 
15 " 60 " 

* a * " 

5 " 20 m. 
30 " 60 " 

2 «' 5 g. 
1 " 3 " 
1 " 3 " 



578 




TABLE OF DOSES. 






Remedies. 


Dose. 




Remedies. 




Dose. 


Oleum copaibas . 


. 8 


to 15 


m. 


Pulv.glycyrrh. comp 


. 30 


to 60 ir. 


cubebaa . . . 


. 15 


" 30 


" 


ipecac, comp. . 


. 5 


" 15 " 


eriger. . . 


. 5 


" 15 


" 


jalapse comp. 


. 30 


« 60 - 


eucalypti . . . 


. 5 


" 10 


1 1 


morphinse comp. 


. 8 


" 15 '• 


gaultherias . . 


. L 


" 20 


m. 


rhei comp. . . 


. 30 


" 60 •• 


phosphoratum . 


. 1 


'« 3 


it 


Pyridine . . . 


. 1 


tt 5 u 


sabinse . . . 


. 1 


" 3 


" 


Pyrodine . . . 


. 1 


<< 3 ■• 


terebinth . 


. 5 


" 30 


" 


j Quinidina (and salts 


) 1 


" 30 •« 


tiglii .... 


• * 


" H 


d. 


Quinina (and salts) 


. 1 


" 30 •' 


Opium (14%morphir 


ieH 


" l| 


g- 


i Quininse arsenias 


• i 


tt 1 <« 


Pancreatin . . . 


. 10 


" 20 


a 


E,esina copaibse . 


. 2 


" 10 •• 


Papayotin . . . 


. 1 


" 5 


" 


guiaici . . . 


. 10 


" 20 " 


Paracotin . . . 


. 1 


" 3 


" 


jalapse . . . 


. 2 


;< 5 t. 


Paraldehyde . . 


. 20 


" 60 


tt 


podophylli . . 


• 1 


tt 1 .. 


Pelleterine. . . 


. 5 


" 10 


" 


scammonii . 


. 2 


u xo ■ 


Pepsinum purum 


. 15 g. to J 


oz. 


Resorcin 


. 2 


a 5 .. 


saccharatum 


. 30 g. to 1 


oz. 


E-heum .... 


. 2 


" 30 - 


Phenacetine . . 


. 2 


" 6 


c< 


Saccharin . . . 


i 


ct 4 t. 


Phosphorus . . 


i 

• T2T 


to io 


g- 


Salicinum . . . 


. 8 


» 30 •• 


Physostigminse salic 


' l"20" 


64" 




Salol 


. 10 


tt 15 ,. 


sulphas . . . 


* T2¥ 


■64 


" 


Santonica . . 


. 8 


" 60 '■ 


Picrotoxinum. . 


1 
"64 


" * 


•' 


Santoninum 


. 1 


" 5 •' 


Pilocarpine, and salt 


s s\ 


it 1 
2 


" 


Sapo . . . . . 


. 5 


" 30 " 


Pil. aloes . . . 


1 


" 3 


oills. 


Scammonium . . 


. 3 


« 15 .. 


aloes et asafcet. . 


. 2 


" 5 


u 


Senna ... 


. 8 


" 60 » 


aloes et ferri . . 


. 1 


■< 3 


<■< 


Sodii acetas . . 


15 


" 60 " 


aloes et mast. . 


1 


" 3 


'• 


arsenias . . . 


i 

6 4 


" JL '• 


aloes et myrrhae 


2 


" 5 




benzoas . . . 


5 


tt 15 .. 


antim. comp. . 


1 


" 3 


" 


bicarb. . . . 


. 8 


" 30 " 


asafoetidse . . 


1 


" 6 


" 


bisulphis . . . 


8 


" 30 '■ 


cathart. comp. . 


1 


" 4 


1 1 


boras 


. 8 


" 30 '• 


ferri comp. . 


2 


" . 5 


" 


bromid . . . 


. 8 


" 30 '• 


ferri iodidi . . 


i 


' c 4 


" 


carb 


8 


" 30 •' 


galbani comp. . 


1 


" 5 


" 


carb. exsicc. 


5 


tt 15 , 


opii .... 


1 


" 2 


•' 


chloras. . 


5 


" 30 '• 


phosphori 


1 


tt 4 


" 


Ijypophosphis . 


8 


t, 15 ,. 


rhei .... 


2 


" 5 


" 


hyposulphis . . 


8 


" 30 " 


rhei comp. . . 


2 


" 5 


'• 


iodidum . . . 


5 


tt 15 ,t 


Piperinum . . . 


1 


" 8 


g- 


phosphas . . . 


2 


" 15 " 


Plumbi acetas . . 


i 


" 3 


" 


salicylas . 


5 


" 30 '■ 


iodidum . . . 


* 


'< 3 


'' 


santoninas . . 


o 


tt 10 tt 


Potassii acetas 


15 


" 60 


" 


sulphas . . . 


1 


tt 2 - 


bicarb. . . 


8 


" 60 


" 


sulphis . . . 


8 


" 30 " 


bitartr. . . . 


1 


" 2 


•' 


Sparteine sulph . 


\ 


t, 4 t. 


bromid. . . . , 


8 


" 60 


" 


Spiritus setheris com- 






carb 


8 


" 30 


" 


positus . . . . 


30 


" 60 m. 


chloras . . . 


8 


" 30 


'■ 


sether. nitrosi . . 


i 


" 2 fl. d 


citras .... 


15 


" 60 


' : 


ammonias . . . 


8 


" 30 m. 


cyanid 


i 

1 6 


" i 


" 


ammonias arom. . 


15 


" 60 « 


et sodii tartr. . . 


i 


" l 


oz. 


camphorse . . . 


8 


" 30 " 


hypophosphis . . 


5 


" 15 


g- 


chloroformi . . . 


15 


" 60 " 


iodid 


2 


<< 15 


it 


lavend. comp. . . 


30 


" 60 " 


nitras 


8 


" 15 


t: 


menth. pip. . . . 


30 


" 60 " 


sulphas . . . . 


1 


u 4 


d. 


Strophanthin . . , 


i 

T6TF 


tt i i. 

TOO 


sulphidum . . . 


I 


« 10 


g- 


Strychnine, and salts 


1 
64 


" T2 g- 


sulphis . . . . 


15 


" 30 


u 


Sulphur 


1 
2 


" 4 d. 


tartras . . . . 


1 


" 8 


d. 


Syr. calcii lactophos . 


1 


" 2 fl. d 


Pulv. antimonialis . 


1 


" 3 


g- 


calcis 


15 


" 30 m. 


aromat 


8 


" 30 


" 


ferri bromid i . . 


15 


' : 60 " 


cretse comp. . . . 


8 


" 30 


" 


ferri iodidi . . . 


15 


tt 4 « 



TABLE OF DOSES. 



579 



Remedies. 


D 


)SE. 


Syr. ferri oxidi 




1 fl. d. 


ferri hypopbosph. 




1 " 


ferri quin et str. pi 


10S. 


1 " 


hypophosphit . 




1 '• 


hypophosph. c. fer 




1 '■ 


ipecac 


* 


■ I «. 


krameria? . . 


1 


4 «. 


lactucarii . . . 


I 


• 3 " 


rhei 


1 


• 4 '• 


rhei arom. . . . 


1 


4 i: 


rosae .... 


1 


■ 2 " 


sarsap. comp. . 


1 


' 4 " 


scilla? .... 


1 


' 1 " 


scilla comp. 


15 


1 60 m. 


senega? . . 


1 


• 2 fl. d 


senna? .... 


1 


• 4 " 


Terebene . . . 


5 


" 10 '• 


Terpine bydrate . 


10 


" 20 ' ; 


Thallin .... 




3 g- 


Tbeine .... 


lg 


hypo. 


Tbymol .... 


1 


" 5 " 


Tinct. aconiti fol. 


8 


• 16 m. 


aconiti rad. . . 


1 


• 5 " 


aeon. rad. Fleming' 


5 t 


' 2J " 


aloes (1880) . . . 


1 


; 2 fl. d 


aloes et myrrha? 


i 


■ 2 « 


arnica? flor. . . 


8 


• 30 m. 


arnica? rad. . . 


15 


• 30 " 


asafcetida? . . 


30 


' 60 " 


belladonna? . . 


8 


• 15 " 


bryonia? . . . 


15 


' 30 " 


calendula? . . 


15 


" 30 < ; 


calumba? . . . 


1 


1 4 fl. d 


cannabis ind. . 


15 


' 30 m. 


cantharid. . . 


8 


' 15 " 


capsici . . 


8 


« 15 - 


catechu comp. . 


i 


" 2 fl d 


cbiretta . . . 


lo 


" 60 m. 


cimicifuga? . . 


30 


" 60 " 


cinchona?. . . 


* 


' 2 fl. d 


cinchona? comp. 


I 


« 2 " 


colchici rad. 


5 


• 15 m. 


colchici sem. . 


6 


' 15 « 


conii .... 


5 


• 30 " 


croci .... 


1 


' 2 fl. d 


cubeba? . . . 


1 


« 2 » 


digitalis . . . 


6 


" 15 m. 


ferri acet. . . 


15 


" 30 » 


ferri chloridi . 


15 


' ; 30 " 


ferri chloridi a?thei 


15 


" 30 '■ 


ferri pomati . . 


20 


" 60 " 


galla? .... 


i 


" 2 fl. d 


gelsemii . . . 


8 


" 15 m. 


guaiaci . . . 


30 


" 60 « 


guaiaci ammon. 


30 


" 60 " 


hellebori . . 


10 


" 15 '• 


humuli . . . 


1 


" 2* fl. d 



Remedies. 
Tinct. hydrastis. 

hyoscyami fol.. 

hyoscyami sem 

ignatia? . . 

iodi . . . 

ipecac, et opii 

jalapa?. . 

kino . 

krameria? 

lavend. comp. 

lobelia? 

lupulini . . 

matico 

moschi 

nux vomica? . 

opii . . . 

opii camph. . 

Phytolacca? . 

physostigmatis 

pyrethri . 

quassia? . 

rhei . . . 

rhei arom. . 

rhei dulc. 

sanguinaria? . 

scilla? . . 

serpentaria? . 

stramon. fol. 

stramon sem. 

sumbul . . 

valer . . . 

valer. ammon. 

veratr. vir. . 

zingiberis 
Tritur. elaterina 
Urethan . . 
Veratrina . . 
Vin. aloes . . 
fexp.et 
\ emet. 

colch. rad. . 

colch. sem. . 

ergota? . . 

ferri amar. . 

ferri citrat . 

f expect 

opii 
rhei 
Zinci acet. 
bromid. 
iodid. . 
oxid. . 
phosphid 
sulphas emet 
valerianas 



Dose. 



antim. 



alt 



4 

3 

15 
* 

io 

1 
1 

30 



90 

30 
30 
15 
15 
15 



ni. 
fl. d. 



2 fl d. 

2 « 

2 " 

2 '■ 
45 

2 

2 
60 
•20 
15 
7-3 
60 
15 
30 

2 

8 
75 

4 
70 
60 

2 

15 
15 

30 

2 

2 
10 
60 " 

2 g- 
15 " 
1 it 

X 2 fl. c 

8 m. 
75 " 
20 " 
30 " 

3 

1 

1 
15 

6 
15 

2 

2 

2 

3 
10 



2 fl. d 

m. 

fl. d. 
m. 



m. 

fl. d. 
m. 



fl. d. 



m. 
fl. d. 

in. 
fl. d. 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Denotes officinal names and preparations of the B. P. not found in the U. S. P. 



ABSORPTION of drugs, 26 
Abstractum aconiti, 36 
Abstractum belladonna?, 76 

conii, 140 

digitalis, 149 

hyoscyami, 149 

ignatia?, 182 

jalapse, 195 

nucis vomica?, 230 

podophylli, 252 

senega?, 268 
Abstracts, 22 
Acacia, 29 
* Acacia? gummi, 29 
Aceta, 22 
Acetanilide, 29 
Acetate of copper, 143 

of lead, 199 

of morphine, 237 

of potassium, 33 

of sodium, 270 

of zinc, 33 
Acetic acid, 34 
Acetphenetidine, 244 
Acetum cantharidis, 99 

lobelia?, 204 

opii, 237 

sanguinariee, 263 

scilla?, 274 
Acid infusion of roses, 257 

nitrate of mercury, 217 
Acidum aceticum, 34 
dilutum, 34 
glaciale, 34 

arseniosum, 69 

benzoicum, 78 

boricum, 80 

carbon cum, 101 
*carbolicum liquefactum. 104 

chromicum, 124 

citricum, 131 

galhcum, 159 

hydrobromicum dilutum, 87 
. hydrochloricum, 171 

hydrochloricum dilutum, 171 

nitricum, 224 
dilutum, 226 

nitro-hydrochloricum, 171. 226 
dilutum, 171, 226 

salicylicum, 258 



Acidum sulphuricum, 280 
aromaticum, 281 
dilutum, 281 
tannicum, 283 
tartaricum, 284 
valeriauicum, 291 
Aconite, 35 
*linirnent, 36 
*ointment, 36 
* Aconiti folia, 36 

*radix, 36 
Aconitine, 36 
Action of drugs, direct, 18 
duration of, 26 
indirect, 18 
mode of, 18 
Acupuncture, 297 
Adeps benzoinatus, 78 
Adhesive plaster, 254 
Administering drugs, mode of, 19 
.Ether, 152 
fortior, 152 
*purus, 156 
Agaric, 37 
Agaricin, 37 
Alcohol, 38 

*amylicuni, 42 
dilutum, 42 
ethylicum, 38 
phenylic, 101 
Alcoholic extract of belladonna, ' 
of conium, 140 
of hyoscyamus, 174 
Ale, 41 
Alkaloids, 22 
Allium. 43 
Allspice, 44 
Almond bread, 43. 332 
Almonds, 43 
bitter, 43 
sweet, 43 
Aloe, 44 

*barbadensis, 44 
purificata, 45 
socotrina, 44 
*Aloin, 44, 46 
Alum, 46 
Alumen, 46 

exsiccatum, 47 
Amber, 48 



582 INDEX OF DRUGS AND REMEDIAL MEASURES, 



Ammonia, 48 

liniment, 50 
Ammoniac, 53 
Ammoniacum, 53 
Ammoniated mercury, 216 

tincture of guaiac, 166 
of valerian, 291 
Ammonii benzoas, 50 

bromidum, 51, 85 

carbonas, 52 

chloridum, 52, 182 

iodidum, 52 

phosphas, 50 

sulphas, 50 

valerianas, 50, 53, 291 
Ammonio-ferric alum, 181 
Amygdala amara, 43 

dulcis, 43 
Amyl nitrite, 53 
Amylic alcohol, 42 
Anthrarobin, 55 
Antidotum arsenici, 70, 179 
Antifebrin, 29 
Antimonial powder, 59 
Antimonii et potassii tartras, 55 

sulphidum, 55 
purificatum, 55 
Antimonium nigrum purificatum, 55 

sulphuratum, 55 
*tartaratum, 55 
Antimony, 55 
Antipyrine, 59 
Antiseptics, 298 
Apiol, 64 

Apomorphinae hydrochloras, 65 
Apomorphine, 64 
Aqua ammonias, 50 
fortior, 50 

amygdalae amarae, 44 

camphorse, 94 
*chloroformi, 123 

cinnamomi, 130 

creasoti, 144 

menthse piperitse, 243 
*pimentse, 44 

rosse, 256 
Aquae, 22 
Arbutin, 290 
*Argenti et potassii nitras, 221 

nitras, 221 
fusus, 221 
dilutus, 224 
Aristol, 65 
Arnica, 65 

flores, 66 

radix, 66 
*rhizoma, 66 
Aromatic chalk powder, 91 
*chalk powder with opium, 91 

mixture of iron, 181 

powder, 107 

spirit of ammonia, 50 

sulphuric acid, 281 

syrup of rhubarb, 255 

tincture of rhubarb, 255 
Arseniate of copper, 66 

of iron, 181 



Arseniate of potassium, 66 

of sodium, 66-69 
Arsenic, 66 
Arsenicum, 66 
Arsenii iodidum, 69 
Arsenious acid, 66-69 
Asafoetida, 71 
Aspidium, 158 
Atomization, 20 
Atropinse sulphas, 73-76 
Atropine, 71 
Azedarach, 71 



BALSAM OF COPAIBA, 141 
Barbadoes aloes, 44 
Barium chloride, 72 
Barley water, 332 
Bath, Russian, 322 

Turkish, 322 
Bearberry, 290 
Beechwood creasote, 143 
Beef essence, 333 

tea, 332 
Beer, 41, 42 
Belladonna, 73 

folia, 73 

liniment, 77 

ointment, 77 

plaster, 77 

radix, 73 
Benzoate of ammonium, 50 

of bismuth, 77 

of lithium, 202 
Benzoated lard, 78 
Benzoic acid, 77 
Benzoin, 77 
Benzoinum, 77 
Berberine, 91, 170 
Bicarbonate of potassium, 78 

of sodium, 78 
Bichloride of mercury, 214, 298 
Bimuriate of quinine and urea, 129 
Biniodide of mercury, 215 
Binoxide of manganese, 206 
Bismuth, 79 
*Bismuthi carbonas, 79 

citras, 79 

et ammonii citras, 79 

subcarbonas, 79 

subnitras, 79 
Bismuthum,'79 
Bisulphate of quinine, 128 
Bisulphide of carbon, 105 
Bitartrate of potassium, 78 
Bitter almonds, 43 

wine of iron, 180 
Black cohosh, 124 

draught, 269 

drop, 237 

ginger, 162 

mustard, 219 

oxide of manganese, 206 

pepper, 242 

snake-root, 124 

wash, 216 
Bleeding, 326 



INDEX OF DRUGS AND REMEDIAL MEASURES. 583 



Blood-root, 263 
Blue mass, 210 

ointment, 211 

pill, 210 
Boneset, 158 
Bonjean's ergotine, 151 
Boracic acid, 80 
Borate of sodium, 80 
Borated lint, 81 
Borax, 80 
Boroglyceride, 80 
Bran bread, 332 
Brandy, 41, 42 
Brayera, 81 
Bromide of ammonium, 51, 85 

of calcium, 86-89 

of iron, 181 

of lithium, 86, 202 

of nickel, 86 

of potassium, 82 

of sodium, 86 
Bromides, 82 
Bromine. 87 
Broom, 266 
Brown mixture, 202 
Brucine, 182 
Buchu, 87 

*folia, 87 
Burgundy pitch, 250 
:;: Butyl-chloral hydras, 115 



CAFFEINES citras, 89 
Caffeine, 88 
Calabar bean, 249 
Calabarine, 249 
Calcium, 89 
Calcii bromidum, 86-89 

carbonas preecipitatus, 89 

chloridum, 89 

hydras, 92 

hypophosphis, 89 

phosphas prsecipitatus, 89 
California buckthorn, 106 
Calomel, 212 * 

ointment, 214 
Calumba, 91 
Calumbine, 91 
Calumbo, 91 
Calx, 92 

chlorata, 118 
*chlorinata, 118 

sulphurata, 92 
Camphor, 93 

liniment, 94 

water, 94 
Camphora monobromata, 94 
Camphorated tincture of opium, 
Camphoric acid, 95 
Canada pitch, 251 
Cannabis Americana, 95 

Indica, 95 
Cantharidal collodion, 99, 139 
Cantharides cerate, 99 

liniment, 99 

paper, 99 
Cantharidin, 97 



Cantharis, 97 
*Capsici fructus, 99 
Capsicum, 99 

fruit, 99 

plaster, 100, 101 
Carbo ligni, 104 
Carbolic acid, 101, 299 
ointment, 104 
Carbon, 104 
Carbonate of ammonium, 52 

*of bismuth, 79 

of lead, 200 

of lithium, 202 

of magnesium, 205 

of potassium, 106 

of zinc, 106 
Carbonici bisulphidum, 105 
*Cardamomi semina, 107 
Cardamom, 107 

seed, 107 
Carron oil, 92 
Caryophyllus, 131 
Cascara cordial, 107 

sagrada, 106 
Cassia fistula, 107 
*Cassiae pulpa, 107 
Castile soap. 270 
Castor oil, 108 
*Cataplasma carbonis, 105 
*conii, 140 
*lini, 159 
*sinapis, 219 
Cataplasms, 22 
Catechu, 109 
Caustic potash, 110 

soda, 111 
Cayenne pepper, 99 
Cerates, 22 
Ceratum camphoree, 94 

cantharidis, 99 

extracti cantharidis, 99 

plumbi subacetatis, 200 

resina, 254 
Cerii oxalas, 111 
Chalk mixture, 89 
Champagne, 41 
Charcoal, 104 

poultice, 105 
Charta cantharidis, 99 
*epispastica, 99 

potassii nitratis, 221 

sinapis, 219 
Charts?, 22 
Chenopodium, 111 
Chimaphila, 111 
Chirata, 112 
Chiretta, 112 
Chloral, 112 

*hydras, 112 
Chloralamide, 115 
Chlorate of potassium, 116 
Chloride of ammonium, 52 

of barium, 72 

of calcium, 89 

of iron, 177 

of mercury, corrosive, 214 

of mercury, mild, 212 



584 INDEX OF DRUGS AND REMEDIAL MEASURES. 



Chloride of sodium, 117 

of zinc, 303 
Chlorinated lime, 118 
Chlorodyne, 123 
Chloroform, 119 

liniment, 123 
*Chloroforrnum, 119 

purificatum, 119 

venale, 119 
Chromic acid, 124 
Chrysophanic acid, 255 
Chrysarobin, 124 

ointment, 124 
Cimicifuga, 124 

racemosa, 124 
*rhizoma, 125 
Cinchona, 125 

calisaya, 125 

condominea, 125 
*cortex, 125 

flava, 125 

micrantha, 125 

pale, 126 
*Cinchona pitayensis, 126 

red, 126 

rubra, 125 
*rubra cortex, 126 

succirubra, 125 

yellow, 126 
Cinchonicin, 126 
Cinchonidin, 126 
Cinchonidinae sulphas, 126-129 
Cinchoninse sulphas, 129 
Cinchonin, 126 
Cinnamon, 129 

water, 130 
*Cinnamomum cortex, 129 
Citrate of bismuth, 79 

of bismuth and ammonium, 

of iron, 180 
*of iron and ammonium, 180 

of iron and quinine, 180 

of iron and strychnine, 180 

ofhthium, 202 

of magnesium, 206 

of potassium, 130 
Citric acid, 131 
Citrine ointment, 217 
Clarets, 42 
Cloves, 131 
*Coca, 132 

erythroxylon, 132, 
*Cocainse hydrochloras, 133 
Cocaine, 13*2 
Codeine, 137 
Cod-liver oil. 134 
Colchicine, 137 
Colchicum, 137 

corn, 137 

seed, 137 
Cold as a remedy, 304 
Cold cream, 256 

pack, 313 
Collodion, 138 
Collodium, 138 

cum cantharide, 99 

flexible, 139 



Collodium, stypticum, 139 

*vesicans, 139 
Colocynth, 139 
*Colocynthidis pulpa, 139 
Cologne water, 42 
Columbo, 91 
Commercial chloroform, 119 

oxide of zinc, 238 
Compound cathartic pills, 139 

effervescing powder, 267 
^Compound decoction of aloes, 46 
of sarsaparilla, 265 
fluid extract of sarsaparilla, 265 
extract of colocynth, 139, 266 
infusion of gentian, 162 

of senna, 269 
liniment of camphor, 94 
liniment of mustard, 219 
mixture of iron, 178 
of liquorice, 202 
of senna, 269 
pill of antimony, 59 
of asafcetida, 71 
*of colocynth, 140 
*of conium, 141 
of iron, 178 
of rhubarb, 255 
*of scammony, 266 
*of soap, 237 
*of squill, 274 
*powder of almonds, 44 
*of catechu, 110 
of chalk, 91 
*of cinnamon, 130 
*of elaterin, 150 
*of ipecac, 192 
of jalap, 195 
*of kino, 196 
of liquorice, 202, 269 
of morphine, 237 
*of opium, 237 
of rhubarb, 255 
*of scammony, 266 
solution of iodine, 188 
spirit of ether/167 
of juniper, 195 
*suppositories of lead, 200 
syrup of sarsaparilla, 265 

of squills, 274 
tincture of benzoin, 78 
*of camphor, 94 
of cardamom, 107 
of catechu, 110 
*of chloroform, 123 
of cinchona, 129 
of gentian, 162 
*Confectio opii, 237 
*piperis, 242 
rosse, 169, 257 
*scammonii, 266 
sennse, 108, 268 
*sulphuris, 280 
terebinthinse, 290 
Confections, 22 
*Conii folia, 140 
*fructus, 140 
Conine, 140 



INDEX OF DRUGS AND REMEDIAL MEASURES. 585 



Conium, 140 

Conserves, 22 

Contra-indications for drugs, 27 

Copaiba, 141 

Copper, 141 

Corrosive chloride- of mercury, 214 

sublimate, 214 
Cosmolme, 244 
Counter-irritation, 314 
Coxe's hive syrup, 59, 274 
Cream of tartar, 78 
Creasote, 143 
Creolin, 143, 302 
Creta prseparata, 91 
Croton chloral, 115 
Croton oil, 144 

*liniment, 144 
Cubebic acid, 145 
Cubebin, 145 
Cubebs, 145 
Cupri acetas, 143 

nitras, 143 

sulphas, 142 
Cuprum, 141 
*Cusso, 81 
Cyanide of potassium, 145 



DANDELION, 284 
Daturine, 275 
Decoctions, 22 

*Decoctum aloes compositum, 46 
*cinchona3, 129 
*haematoxyli, 167 
*pareirse, 241 
*sarsse, 265 

*compositum, 265 
sarsaparilla? compositum, 265 
*scoparii, 267 
*taraxaci, 284 
Definition of therapeutics, 18 
Denarcotized opium, 236 
Deodorized tincture of opium, 236 
Dialyzed iron, 179 

Diet for child six to twelve months old, 331 
one year old, 331 
two years old, 331 
seven years old, 330 
list. 330 
Digitalin, 146, 149 
Digitalis, 146 

*folii, 146, 149 
Dilute acetic acid, 34 
alcohol, 42 

hydrobromic acid, 87 
hydrochloric acid, 171 
hydrocyanic acid, 172 
nitric acid, 226 

nitro-hydrochloric acid, 171, 226 
solution of subacetate of lead, 200 
sulphuric acid, 281 
Dimethyloxyquinizine, 59 
Dioxide of hydrogen, 240 
Disinfection, 318 
Donovan's solution, 69 
Dosage, 23 



Dover's powder, 192, 237 
Dried sulphate of iron, 177 
Drugs, absorption of, 26 

duration of action of, 26 
modes of administering, 19 



ECBOLIC acid, 150 
Ecgonine, 132 
Effervescing draught, 130 

*solution of lithium, 203 
Egg nog, 41 
Elaterin, 149 
Elaterium, 149 
Electuaries, 22 
Elixirs, 22 
Emetine, 192 
Emplastra, 22 

Emplastrum ammoniaci, 53 
cum hydrargyro, 53 
arniese, 66 
asafoetidse, 71 
belladonna?, 77 
*califaciens, 99 
*cantharidis, 99 
capsici, 100, 101 
ferri, 180 
hydrargyri, 217 
opii, 237 

picis burgundicae, 251 
picis canadensis, 251 
picis cum cantharide, 99, 251 
plumbi, 201 
*plumbi iodidi, 201 
resinse, 201, 254 
saponis, 270 
Emulsions of bitter almonds, 44 

of sweet almonds, 43 
Endermic medication, 22 
Enema, 19 
*aloes, 46 
*asafcetidse, 71 
*ruagnesii sulphatis, 205 
*opii, 237 
terebinthinse, 290 
Ergot, 150 
Ergotic acid, 150 
Ergotin, 150 
*Ergotinum, 152 
Erigeron, 152 
Erythroxylon, 132 
Eserine, 249, 250 
*Essentia menthee piperita?, 243 
Ether, 152 
Ethyl alcohol, 38 
bromide, 156 
oxide, 152 
Eucalyptol, 157 
Eucalyptus, 157 
Euonymin, 157 
Euonymus, 157 
Eupatorium, 158 
Extracts, 23 
Extractum aconiti, 36 
*aloes barbadensis, 46 
*socotrin3e, 46 



586 INDEX OF DRUGS AND REMEDIAL MEASURES. 



Extractum arnicas radicis, 66 
*calumbas, 92 

cannabis indicas, 97 
*cascaras sagradas, 107 

cinchonas, 129 , 
*eolchici, 138 

colchici radicis, 138 

colocynthidis, 139 

colocynthidis compositum, 139, 266 
*conii, 140 

digitalis, 149 

ergotas, 151 

euonymii, 158 

gentianas, 162 

glycyrrhizas, 202 
purum, 202 

hasmatoxyli, 167 
*hyoscyami, 174 

jaborandi, 194 
*jalapas, 195 

kramerire, 196 

lupnli, 170 

mezerei, 218 

nucis vomicae, 231 

opii, 236 
*pareiras, 241 

physostigmatis, 250 

podopbylii, 252 

quassias, 253 

rhei, 255 

stramonii, 275 

taraxaci, 284 
*Extractum colcbici aceticuni, 138 
Extractum belladonnas alcoholicum, 76 

conii alcoholicum, 140 
*gelsemii alcoholicum, 162 

hyoscyami alcoholicum, 174 
Extractum aconiti fluidum, 36 

arnicee radicis fluidum, 66 

belladonnas fluidum, 76 

brayeras fluidum, 81 

buchu fluidum, 87 

calumbas fluidum, 92 

cannabis indices fluidum, 97 

capsici fluidum, 101 

chimaphilas fluidum, 112 

chiratse fluidum, 112 

cimicifugse fluidum, 125 

cinchonas fluidum, 129 

colchici radicis fluidum, 138 
seminis fluidum, 138 

conii fluidum, 140 

cubebas fluidum, 145 

digitalis fluidum, 149 

ergotas fluidum, 151 

erythroxyli fluidum, 134 

eucalypti fluidum, 157 

eupatorii fluidum, 158 

gelsemii fluidum, 161 

gentianas fluidum, 162 

geranii fluidum, 162 

glycyrrhizas fluidum, 202 

grindelias fluidum, 165 

hamamelidis fluidum, 167 

hydrastis fluidum, 171 

hyoscyami fluidum, 174 

ipecacuanhas fluidum, 192 



Extractum kramerias fluidum, 196 

lobelias fluidum, 204 

lupulini fluidum, 169 

mezerei fluidum, 218 

nucis vomicas fluidum, 231 

pareiras fluidum, 241 

pilocarpi fluidum, 194 

podophylli fluidum, 252 

pruni virginianae fluidum, 253 

quassias fluidum, 253 

rhei fluidum, 255 

rhus glabras fluidum, 256 

rosas fluidum, 257 

sabinas fluidum, 265 

sanguinarias fluidum, 263 

sarsaparillas compositum fluidum, 265 
fluidum, 265 

scillas fluidum,. 273 

senegas fluidum, 268 

sennas fluidum, 268 

serpentarias fluidum, 269 

spigelias fluidum, 273 
et sennas fluidum, 273 

stillingias fluidum, 274 

stramonii fluidum, 275' 

taraxaci fluidum, 284 

uvas ursi fluidum, 290 

valerianas fluidum, 291 

veratri viridis fluidum, 294 

zingiberis fluidum, 163 
*Extractum cascaras sagradas liquidum, 106 
*cinchonas liquidum, 129 
*cocas liquidum, 134 
*ergotas liquidum, 151 
*filicis liquidum, 158 
*g]ycyrrhizas liquidum, 202 
*opii liquidum 237 
*pareiras liquidum, 241 
*sarsas liquidum, 265 



FERRI arsenias, 181 
bromidum, 181 
carbonas saccharatus, 178 
chloridum, 177 
citras, 180 
dialyzatum, 179 
et ammonii citras, 180 

sulphas, 181 

tartras, 180 
et potassii tartras, 180 
et quininas citras, 180 
et strychnias citras, 180 
iodidum saccharatum, 178 
lactas, 180 
oxalas, 180 
oxidum hydratum, 179 

cum magnesia, 70, 206 
*peroxidum hydratum, 180 
phosphas, 180 
pyrophosphas, 180 
subsulphatis, 179 
sulphas, 177 

exsiccatus, 177 
*granulata, 177 

prascipitatus, 177 
valerianas, 180, 291 



INDEX OF DRUGS AND REMEDIAL MEASURES. 587 



Ferrum, 175 

dialyzatixm, 179 

redactum, 176 
*tartaratum, 180 
*Filix mas, 158 
Flaxseed, 158 

meal, 159 

oil, 159 

poultice, 159 

tea, 159 
Fleabane, 152 

Flemming's tincture of aconite, 36 
Flexible collodion, 139 
Flowers of sulphur, 278 
Fluid extracts, 23 
Flying blister, 315 
Foods for the sick, 328 
Foot-bath, 321 
Fowler's solution, 69 
Fusil oil, 38 



GALLA, 160 
Gallic acid, 159 
Gallic ointment, 160 
Garlic, 43 
Gaultheria, 160 
Gelsemine, 160 
Gelsemium, 160 

General therapeutic considerations, 2 
Gentian, 162 
*Gentianse radix, 162 
Geranium, 162 
German chamomile, 207 

soft soap, 270 
Germicides, 318 

Germs, mode of destroying, 318 
Gin, 41, 42 
Ginger, 162 
Glacial acetic acid, 34 
Glauber's salts, 163 
Glycerin, 163 
Glycerins, 23 
*Glycerinum acidi carbolici, 104, 163 

*galhci, 160, 165 

*tannici, 284 

*alumnus, 48, 165 

*boracis, 81, 165 

*plumbi subacetatis, 165, 200 

*tragacanthse, 165 
Glycerita, 23 
Glycerite of starch, 165 
of yolk of egg, 165 
Glyceritum amyli, 165 
Glycyrrhiza vitella, 165 
*Glycyrrhizse radix, 202 
Glycyrrhizinum ammoniatum, 202 
Goa powder, 124 
Goulard's extract, 200 
Granulated citrate of magnesium, 206 
Gray powder, 211 
Green iodide of mercury, 215 

soap, 270 
Griffith's pills, 128 
Grindelia, 165 
Guaiac, 166 
wood, i66 



Guaiaci lignum, 166 

resina, 166 
Gum arabic, 29 
Gurjun balsam, 166 

oil, 166 



HAMAMELIS, 166 
*Hsematoxyli lignum, 167 
Hsematoxylon, 167 
Heavy magnesia, 205 
Hemlock fruit, 140 

leaves, 140 
Henbane, 173 
Hoffmann's anodyne, 167 
Homatropine hydrobromate, 168 
Home modification of Turkish bath, 324 
Honey, 169 
*of borax, 81 

of rose, 169, 257 
Hop poultice, 169 
Hope's camphor mixture, 170 
Hops, 169 
Humulus, 169 

Hydrargyri chloridum corroslvurn, 214 
mite, 212 

iodidum rubrum, 215 
viride, 215 

oxidum flavum, 215 

rubrum, 215 
*perchloridum, 214 
*subchloridum, 212 

subsulphas flavus, 217 
Hydrargyrum, 207 

ammoniatum, 216 

cum creta, 211 
Hydrastin, 170 
Hydrastis, 170 
Hydrate of chloral, 112 
Hydrated oxide of iron with magnesium, 179 

peroxide of iron, 180 

sesquioxide of iron, 179 
Hydrobromate of homatropine, 168 

of quinine, 129 
Hydrobromic acid, 87 
Hydrochlorate of cocaine, 133 

of morphine, 237 

of pilocarpine, 194 

of quinine, 129 

of thallin, 285 
Hydrochloric acid, 171 
Hydrocyanic acid, 171 
Hydrogen dioxide, 240 

peroxide, 240, 302 
Hyoscine, 173, 174 
*Hyoscyami folia, 173 
Hyoscyaminse sulphas, 174 
Hyoscy amine, 173 
Hyoscyamus leaves, 173 
Hypodermic medication, 21 

injection of apomorpbine, 65 
Hypophosphite of calcium, 89 



ICE JACKET, 306 
poultice, 306 
Ichthyol, 175 



588 INDEX OF DRUGS AND REMEDIAL MEASURES 



Idiosyncrasy, 24 
Ignatia, 182 

bean, 182 
Indian hemp, 95 

poke, 292 
Indications for drugs, 27 
Infusions, 23 
Infusum brayerse, 81 
*buchu, 87 
*calumbse, 92 
*caryophylli, 132 
*catechu, 110 
*chirat8e, 112 
cinchonee, 129 
*cinchonse acidum, 129 
*cusso, 81 
digitalis, 149 
*ergotse, 151 

*gentianee compositum, 162 
*jaborandi, 194 
^kramerise, 196 
*lini, 159 
*lupuli, 170 
pruni virginianse, 253 
*quassise, 253 
s rhei, 255 
^rosse acidum, 257 
*senegse, 268 
*sennae, 269 

compositum, 207, 269 
*serpentaria, 269 
*uvse ursi, 290 
*valerianse, 291 
Inhalations, 20 

*Injectio apomorphinse hypodermica, 65 
^ergotini hypodermica, 152 
*morphinae hypodermica, 238 
Inunctions, 22 
Iodide of ammonium, 182 
of arsenic, 69 
of iron, 178 
of lead, 201 
of potassium, 182 
of sodium, 185 
Iodine, 185 

liniment, 188 
ointment, 189 
Iodoform, 189, 301 
ointment, 190 
Iodol, 190 
Iodum, 185 
Ipecac, 190 
Iron, 175 

plaster, 180 

* TABORANDI, 192 
t) Jalap, 194 
Jalapin, 194 
Jamestown weed, 275 
James's powder, 59 
Jervine, 292 
Juniper, 195 
Joint effects of drugs, 28 

KAMALA, 196 
Kataphoresis, 326 
Kino, 196 



Koosin, 81 
Kousso, 81 
Koumyss, 330 
Krameria, 196 
*radix, 196 
Kreolin, 302 



LACTATE OF IRON, 180 
Lady Webster's dinner pills, 46 
*Lamell8e atropinae, 77 
*cocainse, 134 
*physostigminse, 250 
Lanolin, 197 
Laudanine, 231 
Laudanum, 236 
Lead, 197 

acetate ointment, 200 
plaster, 201 

water and laudanum, 200 
Ledoyen's disinfectant solution, 201 
Levant worm-seed, 263 
Light magnesia, 205 
Lignum vitae, 166 
Lime, 92 

water, 92 
Linseed, 158 

poultice, 159 
*Lini farina, 159 
*semina, 158 
*Linimentum aconiti, 36 
ammoniae, 50 
belladonnas, 77 
calcis, 92 
camphorse, 94 

*compositum, 94 
cantharidis, 99 
chloroformi, 123 
*crotonis, 144 
*hydrargyri, 217 
*iodi, 188 
*opii, 237 

*potassii iodidi cum sapone, 184 
plumbi subacetatis, 200 
saponis, 270 

sinapis compositum, 219 
terebinthinae, 290 
*aceticum, 290 
Linum, 158 
Lipanin, 201 

Liquor acidi arseniosi, 69 

*acidi chromici, 124 

*ammoni8e, 50 

acetatis, 50 

*fortior, 50 

*ammonii citratis, 50 

*fortior, 50 
*antimonii chloridi, 59 
*arsenici hydrochloricus, 69 
*arsenicalis, 69 

arsenii et hydrargyri iodidi, 69 
*atropina3 sulphatis, 77 
*bismuthi et ammonii citras, 79 
calcis, 72 

*saccharatus, 92 
*epispasticus, 99 
*ferri acetatis, 180 



INDEX OF DRUGS AND REMEDIAL MEASURES 



589 



* Liquor ferri fortior, 180 
ferri citratis, 180 
*ferri dialyzatus, 179 
ferri et quinina? citratis, 180 
*ferri perchloridi, 177 

*fortior, 177 
ferri subsulphatis, 178 
hydrargyri nitratis, 217 
*perchloridi, 215 
*iodi, 188 

compositus, 188 
*lithiae effervescens, 203 
*rnagnesii carbonatis, 206 

citratis, 206 
*morphina? acetatis, 238 
*hydrochloratis, 237 
sulphatis, 237 
pepsini, 243 
plumbi subacetatis, 200 

dilutus, 200 
potassa?, 203 
potassii arsenitis, 69 
citratis, 130 
*permanganas, 244 
soda?, 111 

sodii arseniatis, 69 
zinci chloridi, 117 
Liquorice, 202 

root, 202 
Lister's dressing, 303 
Litbarge, 201 
Litbia water, 203 
Litbii benzoas, 202 
bromidum, 86, 202 
carbonas, 202 
citras, 202 
salicylas, 202 
Lithium, 202 
Lobelia, 203 
Log- wood, 167 
*Lotio bydrargyri fiava, 216 

*nigra, 216 
Lozenges, 23 
Lugol's solution, 188 
Lunar caustic, 221 
Lupulin, 169 
*Lupulus, 169 
Lycopodium, 204 



MACE, 220 
Magendie's solution, 237 
Magnesia, 205 
*levis, 205 

ponderosa, 205 
Magnesii citras, 206 

citras granulatus, 206 

sulphas, 205 
Magnesium, 204 
Male fern, 158 
Mandrake, 252 
Manganese, 206 
Mangani oxidum nigrum, 206 

sulphas, 206 
Manganum, 206 
Manna, 206 



Massa copaiba?, 141 

hydrargyri, 210 
Matricaria, 207 
May apple, 252 
Meconic acid, 231 
Meconine, 231 
Mel, 169 

*boracis, 81 
*depuratum, 169 

despumatum, 169 

rosee, 169, 257 
Mentha? piperita, 242 
Mercurial ointment, 211 

oleate, 211 

pills, 210 

plaster, 217 

suppositories, 216 
Mercury, 207 

with chalk, 211 
Methyl chloride, 218 
*Mezerei cortex, 218 
Mezereum, 218 

ointment, 218 
Mild chloride of mercury, 212 
Milk of asafcetida, 71 
Milk punch, 41 

peptonized, 328 

sugar, 276 
Mistura ammoniaci, 53 

amygdalee, 44 

asafcetida?, 71 

chloroform!, 123 
*creasoti, 144 

creta, 89 
*ferri aromatica, 181 

ferri composita, 178 

ferri et ammonii acetatis, 180 

glycyrrhiza? composita, 202 
*guaiaci, 166 

potassii citratis, 130 

rhei et soda?, 255 
*scammonii, 266 
*senna? composita, 269 
*spiritus vini gallici, 42 
Mitigated caustic, 224 
Mode of action of drugs, 18 
Modes of administering drugs, 19 
Monkshood, 35 
Monobromate of camphor, 94 
Monsel's salt, 179 

solution, 178 
Morphina? acetas, 237 

hydrochloras, 237 

sulphas, 237 
Morphine, 237 
Moschus, 218 
Mucilage of acacia, 29 
Mucilago acacia?, 29 
Mulled wine, 41, 334 
Muriate of ammonium, 52 

of morphine, 237 
Musk, 218 
Mustard, 219 

papers, 219 

plaster, 219, 317 
Myristica, 220 
Myrrh, 220 



590 INDEX OF DRUGS AND REMEDIAL MEASURES, 



■VTAPHTHALIN, 220 
-LN Narceine, 231 
Narcoteine, 231 
Neutral mixture, 130 
Nicotine, 287 
Nitrate of copper, 113 

of lead, 201 
*of pilocarpine, 194 

of potassium, 221 

of silver, 221 
Nitre, 221 
Nitric acid, 224 
Nitrite of amyl, 53 

of potassium, 226 
Nitroglycerine, 226 
Nitro-hydrochloric acid, 226 
Norwood's tincture of veratrum viride, 294 
Nut-galls, 160 
Nutmeg, 220 
Nux vomica, 228 



OIL of tar, 251 
of vitriol, 280 
Ointment of aconite, 36 

of ammoniated mercury, 216 

of antimony, 59 
*of atropine, 77 

of belladonna, 77 
*of cantharides, 99 

of carbonate of lead, 201 

of chrysarobin, 124 
*of creasote, 144 
*of eucalyptus, 157 

of gallic acid, 160 

of galls, 160 

*with opium, 160 

of iodide of lead, 201 
of potassium, 184 

of iodine, 189 

of iodoform, 190 
*of lead acetate, 200 

of mercury, 211 

of nitrate of mercury, 217 

of oxide of zinc, 238 

of petrolatum, 244 
*of red iodide of mercury, 215 
oxide of rnercury, 216 

of resin, 254 

of rose water, 256 

of salicylic acid, 261 
*of savine, 265 

of stramonium, 275 

of sulphur, 279 

of tannic acid, 284 

of tar, 251 
*of tartrate of antimony, 59 

of turpentine, 290 

of veratrine, 292 

of yellow oxide of mercury, 216 
Ointments, 23 
Oleatum hydrargyri, 211, 215 

veratrinse, 292 
Oleoresina aspidii, 158 

capsici, 101 

cubeba?, 145 

lupulini, 169 



Oleoresina piperis, 242 

zingiberis, 163 
Oleum amygdala? amara?, 43 
expressum, 44 

cajuputi, 89 

caryophylli, 131 

chenopodii, 111 

cinnamomi, 130 

copaibse, 141 
*crotonis, 144 

cubeba?, 145 

erigerontis, 152 

eucalypti, 157 

gaultheria?, 160 

juniperi, 196 

lini, 159 

mentha? piperita?. 243 

morrhua?, 134 

myristica?, 221 

picis liquida?, 251 

pimenta?, 44 

phosphoratum, 21!) 

ricini, 108 

ruta?, 257 

sabina?, 265 

santali, 262 
*sinapis, 219 

volatile, 219 

succini, 48 

tanacetum, 284 

terebinthinse, 28S 

tigli, 144 

Valeriana?, 291 
Opium, 231 

denarcotized, 236 
Opodeldoc, 270 
Oxalate of cerium, ill 

of iron, 180 
Oxide of antimony, 55 

of lead, 201 

of zinc, 238 
Oxygen, 239 

peroxide, 239 

water, 239 

*Oxymel, 169 

*scilla?, 274 



PALE cinchona, 126 
rose, 256 
Pancreatin, 240 
Papaverine. 231 
Papers, 22 
Paraldehyde, 241 
Parachinanisol, 285 
Paregoric, 236 
Pareira, 241 
Pareira? radix, 241 
Parsley, 64 
Pepo, 242 
Pepper, 242 
Peppermint, 242 

water, 243 
*Pepsin, 243 

Pepsinum saccharatum, 243 
Peptonized beef, 329 

gruel, 329 



INDEX OF DRUGS AND REMEDIAL MEASURES. 591 



Peptonized milk, 328 
punch, 828 
oysters, 329 
Permanganate Of potassium, 243 
Peroxide of hydrogen, 240, 302 

of oxygen, 239. 
Petrolatum, 244 
Petroselinum, 64 
Phenacetine, 244 
Phenic acid, 101 
Phenol, 101 
Phenylic alcohol, 101 
Phlebotomy, 326 
Phosphate of ammonium, 50 
of iron, 180 
of sodium, 246 
Phosphide of zinc, 246 
Phosphorated oil, 249 
Phosphorus, 247 
*Physostigma, 249 
Physostigmatis semen, 249 
*Physostiginina, 250 
Physostigmine, 249 
Pill of three valerianates, 291 
Pills, 23 
Pilocarpine hydrochloras, 194 

*nitras, 194 
Pilocarpine, 192 
*Pilula asafcetidae composita, 71 
*colocynthidis composita, 140 

*et hyoscyami, 140 
*conii composita, 141 
*ferri carbonatis, 178 
*hydrargyri, 210 
*ipecacuanhse cum scilla, 192 
*plumbi cum opio, 200 
*saponis composita, 237 
*scammonii composita, 266 
*scillae composita, 274 
Pilulae aloes, 46 

et asafcetidae, 46 
et ferri, 46 
et mastiches, 46 
et myrrh, 46 
antimonii composite, 59 
asafcetidae, 71 
catharticae composita?, 139 
ferri compositae, 178 

iodidi, 178 
opii, 236 
phosphori, 249 
rhei, 255 

compositae, 255 
Pimenta, 44 
Pinkroot, 272 
Piper, 242 

nigrum, 242 
Piperine, 242 
Pipsissewa, 111 
Pitch, 250 
Pix, 250 

burgundica, 250 
canadensis, 251 
liquida, 251 
Plasma, 165 
Plaster of ammoniac. 53 



Plaster of ammoniac with mercury, 53 

of arnica, 66 

of asafoetida, 71 

of belladonna, 71 

of Burgundy pitch, 251 

of Canada pitch, 251 
*of cantharides, 99 

of capsicum, 100. 101 

of iron, 180 

of lead, 201 

of mercury, 217 

of opium, 237 

of resin, 201, 254 

of soap, 270 

of tar, 251 
Plasters, 22 
Plumbi acetas, 199 

carbonas, 200 

iodidum, 201 

nitras, 201 

oxidum, 201 
Plumbum, 197 
Podophyllum, 252 
*Podophylli rhizoma, 252 
Poke root, 292 
Polygalic acid, 268 
Port wine, 42 
Porter, 42 
Potassa, 110 
: ' :: caustica, 110 

cum calce, 294 
Potash papers, 221 
Potassii acetas, 33 

bicarbonas, 78 

bitartras, 78 

bromidum, 82 

carbonas, 106 

chloras, 116 

citras, 130 

cyanidum, 145 

et sodii tartras, 256 

iodidum, 182 

nitras, 221 

perrnanganaS; 243 
*tartras acida, 78 
Precipitated carbonate of calcium, 89 

carbonate of zinc, 106 

phosphate of calcium, 89 

sulphate of iron, 177 

sulphur, 278 
Prepared chalk, 91 
Proof spirit, 42 
Protiodide of mercury, 215 
Prunus virginiana, 252 
Prussic acid, 171 
Pseudomorphine, 231 
*Pterocarpi lignum, 262 
*Pulvis amygdalae compositus, 44 

antimoniahs, 59 

aromaticus, 107, 130 
*catechu compositus, 110 
*cinnamomi compositus, 130 
*cretae aromaticus, 91 
*cum opio, 91 
compositus, 91 

effervescens compositus, 267 



592 INDEX OF DRUGS AND REMEDIAL MEASURES. 



*Pulvis elaterini compositus, 150 

glycyrrhizse compositus, 202, 269 

ipecacuanha compositus, 192 
et opii, 192, 237 

jalapse compositus, 195 
*kino compositus, 196 

morphinse compositus, 237 

opii, 236 

^compositus, 237 

rhei compositus, 255 
*scammonii compositus, 266 
Pumpkin seed, 242 
Punch, milk, 41 
Pure ether, 156 
Purging cassia, 107 
Purified aloes, 45 

chloroform, 119 

sulphide of antimony, 55 
Pyridine! 287 

Pyrophosphate of iron, 180 
Punk, 37 



QUASSIA, 253 
*Quassi8e lignum, 253 
Queen's root, 274 
Quercus alba, 253 

tinctora, 253 
Quevenne's iron, 176 
Quicksilver, 207 
Quinicine, 126 
Quinidinse sulphas, 129 
Quininse bisulphas, 128 
hydrohromas, 129 
hydrochloras, 129 
valerianas, 129, 291 
Quinine 



RASPBERRY, 257 
Rectified spirit, 42 
Red cinchona, 126 

iodide of mercury, 215 

oxide of mercury, 215 

precipitate, 215 
ointment, 216 

rose, 256 

saunders, 262 

wine, 42 
Reduced iron, 176 

Remedial measures other than drugs, 297 
Remedy, cold as a, 304 
Resin, 254 

ointment, 254 

plaster, 201, 254 
Resina, 254 

jalapse, 195 

podophylli, 252 

seammonii, 266 
Resorcin, 254 
Rhatany, 196 
Rheum, 254 

*radix, 254 
Rhubarb, 254 
Rhus aromatica, 255 

glabra, 256 
Rochelle salt, 256 



Rosa centifolia, 256 

gallica, 256 
Rose water, 256 
Rosin, 254 
Rottlera, 196 
Rubus idseus, 257 
Rue, 257 

Rules for dosage, 24 
Rum, 42 
Russian bath, 322 



SABINA, 265 
Saccharated carbonate of iron, 178 
Saccharated iodide of iron, 178 
pepsin, 243 

*solution of lime, 92 
Saccharin, 257 
Saccharum, 276 
lactis, 276 
officinarum, 276 

*purificatum, 276 
Sal prunella, 221 
Salicylate of lithium, 202, 262 
of mercury, 258 
of sodium, 262 
Salicylic acid, 258 

*ointment, 261 
Salol, 262 
Saltpetre, 221 
Salts, 205 
Sandalwood, 262 
Sanguinaria, 263 
Santalum rubrum, 262 
Santonin, 263 

Santoninate of sodium, 264 
Santoninic acid, 263 
Santoninum, 263 
Sapo, 270 

*duris, 270 

*mollis, 270 
viridis, 270 
*Sarsse radix, 264 
Sarsaparilla, 264 
*Savinee cacumina, 265 
Savine, 265 

ointment, 265 
Scammonium, 266 
Scammony. 266 
Scilla, 273 
Scillin, 273 
Scillipikrin, 273 
Scillitoxin, 273 
Sclerotinic acid, 150 
*Scopari cacumina, 266 
Scoparius, 266 
Seidlitz powder, 267 
Senega, 268 
*Senegee radix, 268 
Senna, 268 

*alexandrina, 268 

*indica, 268 
Serpentaria, 269 

*rhizorna, 269 
Sherry, 42 

Silicate of potassium, 269 
Sinapis alba, 219 



INDEX OF DRUGS AND REMEDIAL MEASURES. 593 



*Sinapis albse seminrc, 219 
nigra, 219 
• ;: nigrse seminae, 219 
Sinapisnia. 219 
Slaked lime. 92 
Smooth sumach, 256 
Soap, 270 

liniment. 94, 270 
plaster, 270 
Soda, ill 

*caustica, ill 
*tartarata, 256 
Sodii acetas, 69 
arsenias. 69 
bi carbon as, 78 
boras, 80 
bromidum, 86 
chloridum, 117 
et potassii tartras, 256 
iodidum, 185 
phosphas, 246 
salicylas, 262 
santoninas, 264 
sulphas, 163 
*tartarata, 256 
Sodium. 270 
Sodium ethylate, 271 
Soluble glass, 269 

Solxition of acetate of ammonhim. 50 
of acetate of iron, 180 
*of morphine, 238 
of ammonia, 50 
of arseniate of potassium, 69 

of sodium, 69 
of arsenious acid, 69 
*of carbonate of magnesium. 206 
*of chloride of antimony, 59 

of zinc, 117 
*of chlorinated lime, 118 
of citrate of ammonium, 50 

of bismuth and ammonium, 79 
of iron, 180 

of iron and quinine, 180 
*of magnesium, 206 
of potassium, 130 
*of hydrochlorate of morphine, 237 
of iodide of arsenic and mercury. 69 
*of iodine, 188 
of lime, 92 

of nitrate of mercury, 217 
of pepsin, 243 

*of perchloride of mercury, 215 
*of permanganate of potassium, 244 
of potassa, 203 
of soda, 111 

of subacetate of lead, 200 
^Solution of sulphate of atropine. 77 

of sulphate of morphine, 237 
Somnal, 271 
Sozoiodol. 271 
Spanish fly, 97 
Sparteine, 266 
Spice plaster, 317 
Spigelia, 272 
Spirit of Mindererus, 50 
of turpentine, 288 
' Spiritus setheris, 156 



Spiritus compositus, 167 
nitrosi. 281 
ammonia', 50 

aromaticus, 50 
*fcetidus, 50 
*cajuputi, S9 
camphoric, 94 
chloroformi, 123 
cinnamomi, 130 
frumenti, 42 
gaultheria?, 160 
juniperi, 196 

compositus, 42 
mentha- piperita, 243 
myristicse, 221 
odoratus, 42 
*rectificatus, 42 
*tenuior, 42 
vini gallici, 42 
Squill, 273 

Squirting cucumber, 149 
Stillingia, 274 
Stramonii folia, 275 

semen, 275 
Stramonium, 275 
^Stronger ammonia, 50 
ether, 152 

water of ammonia, 50 
*solution of acetate of ammonia, 50 
*ofiron, 180 

*of citrate of ammonia, 50 
*of perchloride of iron. 177 
Strophanthin, 275 
Strophanthus, 275 
Strychnine sulphas, 231 
| Strychnine, 228 
Styptic collodion, 139 
Subcarbonate of bismuth, 79 
Sublimed sulphur, 278 
Subnitrate of bismuth, 79 
Subsulphate of iron, 179 
Succinum, 48 
*Succus belladonna?, 76 
*conii, 140 
*hyoscyami, 174 
*limonis, 131 
*scoparii, 267 
*taraxaci, 284 
Sugar, 276 

of lead, 199 
of milk, 276 
Sulphate of ammoniiun, 50 
of atropine, 73, 76 
of cinchonidine, 129 
of cinchonine, 129 
of copper, 142 
of hyoscyamus, 174 
of iron, 177 

and ammonium, 181 
of magnesium, 205 
of manganese, 206 
of morphine, 237 
of quinidine, 129 
of sodium, 163 
of strychnine, 231 
of thallin, 285 
of zinc, 276 
38 



594 INDEX OF DRUGS AND REMEDIAL MEASURES. 



*Sulphide of ammonium, 50 
of antimony, 55 
of calcium, 91, 277 
Sulphides, 276 
Sulphonal, 277 
Sulphur, 278 
lotum, 278 
ointment, 279 
prsecipitatum, 278 
sublimatum, 278 
Sulphurated antimony, 55 

lime, 92 
Sulphuric acid, 280 

ether, 152 
Sumach, smooth, 256 
Sumbul, 281 

*radix, 281 
*Suppositoria acidi carbolici cum sapone, 104 
*tannici, 284 
*hydrargyri, 216 
*iodoformi, 190 
*morphinse, 238 

*cum sapone, 238 
*plumbi composita, 200 
Suppositories, 23 
Swamp hellebore, 292 
Sweet almonds, 43 
spirit of nitre, 281 
sumach, 255 
Sydenham's laudanum, 237 
Syrup of tar, 251 
Syrupus acacise, 29 
acidi citrici, 131 
aim, 43 
amygdalae, 44 
calci lactophosphatis, 90 
*chloral, 114 
ferri bromidi, 181 

iodidi, 178 
phosphatis, 180 

quininse et strychninse phosphatum,180 
hypophosphitum, 90 

cum ferro, 180 
ipecacuanhas, 192 
kramerise, 196 
*limonis. 131 
picis liquidee, 251 
pruni virginianse, 253 
rhei, 255 

aromaticus, 255 
rosse, 257 
rubi idsei, 257 

sarsaparillae compositus, 265 
scillas, 274 

compositus, 59, 274 
senega?, 268 
sennse, 269 
zingiberis, 163 



TABACUM, 287 
*folia, 287 



*Tabellse nitroglycerini, 226 
*Tablets of nitroglycerin, 226 
Tamarinds, 283 
Tamarindus, 283 



Tanacetum, 284 
Tannic acid, 283 
Tansy, 284 
tea, 284 
Tar, 251 

ointment. 251 
water, 251 
Taraxacum, 284 
Tartar emetic, 55 
Tartaric acid, 284 

Tartrate of antimony and potassium, 55 
of iron and ammonium, 180 

and potassium , 180 
of potassium and sodium, 256 
of thallin, 285 
Terebene.285 
Terebinthina, 288 
Thallin, 285 
Thebaine, 231 
Theine, 88 
Therapeutic considerations, 17 

nihilism, 17 
Therapeutics, definition of, 18 
Thoroughwort, 158 
Thymol, 286 
Tinctura aconiti. 36 
aloes, 46 

et myrrhae, 46 
*arnicse, 66 

florum, 66 
radix. 66 
asafcetida, 71 
belladonna, 76 
benzoini, 78 

composita, 78 
*buchu, 87 
calumbse, 92 

*cainphorse composita, 94, 236 
cannabis indicse, 97 
cantharidis, 99 
capsici, 101 
cardamomi, 107 
composita. 107 , 
*catechu, 110 

composita, 110 
chiratse, 112 
:;: chloroformi composita, 123 

*et morphinse, 123, 238 
cimicifugge, 125 
cinchonae, 129 

composita, 129 
cinnamomi, 130 
colchici seminis, 138 
conii, 140 
cubebae, 145 
digitalis, 149 
*ergotse, 151 
ferri chioridi, 177 

*perchloridi, 177 
gallee, 160 
gelsemii, 161 
gentianse composita, 162 
guaiaci, 166 

ammoniata, 166 
humuli, 169 
hydrastis, 171 
hyoscvami. 174 



INDEX OF DRUGS AND REMEDIAL MEASURES. 595 



Tinctura ignatiae, 182 
iodi, 18S 

ipecacuanha; et opii, 237 
*jaborandi, 194 
*jalapa?, 195 
kino, 196 
krameria?, 196 
lobelias, 204 

*etherea, 204 
*lupuli, 170 
moschi, 219 
myrrhae, 220 
nucis vomica?, 231 
opii, 236 

*ammoniata, 237 
camphorata, 236 
deodorata, 236 
physostigmatis. 250 
*podophylli, 252 
quassia?, 253 

*quinina? aramoniata, 129 
rhei, 255 

aromatica, 255 
dulcis, 255 
*sabina?, 265 
sanguinaria?, 263 
saponis viridis, 270 
scillse, 273 
• :: seneg8e, 268 
senna?, 269 
serpentaria\ 269 
stramonii, 275 
sumbul, 281 
Valeriana?, 291 

aronioniata. 291 
veratri viridis, 294 
zingiberis, 163 
*fortior, 163 
Tinctures, 23 
Tobacco, 287 
Touchwood, 37 
Triturates, 23 
Trituratio elaterini, 150 
Troches, 23 

- ;: Trochisci acidi benzoici, 78 
tannici, 284 
*bismuthi, 79 
catechu, 110 
cretse, 91 
cubeba?, 145 
*ferri redacti, 176 
glycyrrhiza? et opii, 202 
ipecacuanha?, 192 
krameria?, 196 
magnesia?, 205 
mentha? piperita?, 243 
morphina?, 238 

et ipecacuanha?, 192, 237 
opii. 237 

notassii chloratis, 117 
*santonini, 264 
sodii santoninatis, 264 
zingiberis, 163 
Turkish bath, 322 

home modification of, 324 
Turpentine, 288 
liniment, 290 



Turpentine stupe, 28 
Turpeth mineral, 21' 



UNGUENTUM acidi carbolici. 104 
gallici, 160 
*salicylici, 261 
tannici, 284 
aconitina?, 36 
*antimonii tartarati, 59 
aqua? rosa?, 256 
*atropina?, 77 
belladonna?, 77 
*cantharidis, 99 
*cetacei, 78 
ciirysarobini, 124 
*creasoti, 144 
^eucalypti, 157 
galla?, 160 

*cum opio, 160 
hydrargyri. 211 
ammoniati, 216 
*iodidi rubri, 215 
nitratis, 217 

*dilutum, 217 
oxidi flavi, 216 
rubri, 216 
*subchloridi, 214 
iodidi, 189 
iodoformi, 190 
petrolei, 244 
picis liquida?, 251 
*plumbi acetatis, 200 
carbonatis, 201 
*iodidi, 201 
potassii iodi, 184 
*resinse, 254 
*sabina?, 265 
stramonii, 275 
sulphuris, 279 
*terebinthina?, 290 
veratrina?, 292 
zinci oxidi, 238 
Ursin, 290 
Uva ursi, 290 
*Uvae ursi folia, 290 



XTALERIAN, 290 

V *Valeriana rhizoma. 290 
Valerianate of ammonium, 50,53, 291 
of iron, 180, 291 
of quinine, 129, 291 
of zinc, 291 
Valerianic acid, 291 
*Vapor acidi hydrocyanici, 173 
*chlori, 118 
*conii, 141 
*creasoti, 144 
*iodi, 188 
Vaseline, 244 
Venesection, 326 
* Veratri viridis rhizoma, 292 
Veratrina, 291 
Veratrine ointment, 292 
Veratroidine, 293 
Veratrum viride, 292 



596 INDEX OF DRUGS AND REMEDIAL MEASURES. 



Vienna paste, 110, 294 
Vinegar, 34 

of lobelia, 204 
of opium, 237 
of sanguinaria, 263 
of squill, 273 
Vinegars, 22 
Vinum album, 42 
aloes, 46 
antimoniale, 58 
antimonii, 58 
*colchici, 138 
radicis, 138 
seminis, 138 
ergotse, 151 
*ferri, 181 

amarum, 180 
ipecacuanha?, 192 
opii, 237 
picis, 251 
portense, 42 
*quinin8e, 129 
rbei, 255 
rubrum, 42 
tabaci, 287 
xericum, 42 
Virginia snake-root, 269 



WAHOO, 157 
Warburg's tincture, 294 
Warming plaster, 99 
Wash, black, 216 

yellow, 216 
Washed sulphur, 278 
Weaker water of ammonia, 50 
Wet pack, 322 
Whiskey, 42 
White ginger, 162 
mustard, 219 
oak, 253 
precipitate, 216 
ointment, 216 



Wild cherry, 252 
Wine of aloes, 46 

of antimony, 58 

of colchicum root, 13S 
seed, 138 

of ergot, 151 

of iron, 181 
bitter, 180 

of ipecac, 192 

of opium, 237 

of rhubarb, 255 

of tar, 251 

of tobacco, 287 

whey, 41, 332 
Wines, 23 
Wintergreen, 169 
Witch-hazel, 166 
Wood oil, 166 
Worm seed, 111 



^7-ANTHOPUCCINE, 170 



YELLOW CINCHONA, 126 
jessamine, 160 
oxide of mercury, 215 
sulphate of mercury, 217 
Avash, 216 
Young's rule for dosage, 24 



ZINC, 295 
Zinci acetas, 34 
*Zinci carbonas, 104 

praecipitatus, 104 
oxidum, 238 

venale, 238 
phosphidum, 246 
sulphas, 276 
valerianas, 291 
Zingiber, 162 



INDEX OF DISEASES AND REMEDIES. 



ABORTION, 335 

Antiseptic irrigation as an after-treatment, 337 

Cascara sagrada, or compound liquorice pow- 
der, as a laxative ; if they fail, rhubarb or 
castor-oil, 335 

Cimicifuga, fluid extract, gtt. 10 to 20, night 
and morning, as a prophylactic, 336 

Diet and hygiene, 335 

Elaterium, jalap, scammony, strychnine, 
erigeron, .cantharides, contra-indicated, 
unless very necessary, 336 

Ergot and quinine, in small doses, with per- 
fect rest for one or two weeks, as an after- 
treatment, 337 

Iodine, applied to the inner surface of uterus, 
after removal of membranes, as a haemo- 
static and antiseptic, 337 

Opium and morphine, best agents to quiet 
uterus if abortion threatens, 336 

Quinine, useful in malarial poisoning, as a 
preventive ; in other cases contra-indi- 
cated, 336 

Saline purges contra-indicated, except in 
plethoric women, 335 

Tampons of absorbent cotton, dusted with 
iodoform, followed by ergot, if abortion is 
inevitable, 336 

Venesection, useful in plethoric women to 
prevent, 336 

Viburnum prunifolium, fluid extract, drachm 
1 to \y 2 , taken during pregnancy as a pro- 
phylactic, 336 

ABRASIONS. 

Collodion, flexile, painted over part, to render 
wound water-proof and air-tight, 138 

ABSCESS, 337 

Aconite or veratrum viride, in full dose, often 
aborts, 337 

Alcohol, given with milk, in cold abscess, 338 

Belladonna ointment, locally applied, to abort ; 
or tincture, internally, if aconite is not at 
hand, 337 

Carbolic acid, minims 5 to 10 of 2 per cent, solu- 
tion, injected into gland threatening sup- 
puration, 337 

Hydrogen peroxide. 10 per cent, solution, to 
wash out cavity of tubercular or slow ab- 
scess, 240, 338 



Incision, if pus forms, followed by irrigation 
with carbolic acid (1 to 20) or bichloride 
solution (1 to 5000) and antiseptic dressing, 
338 
Iodine, locally applied, may abort, 337 
Iodoform gauze, packed into cavity, or ethereal 
solution injected after aspiration, and anti- 
septic dressing, useful in tubercular ab- 
scess, 338 
Lead-water, applied on bread-crumb poultice 

or lint, in early stage, to abort, 337 
Nitrate of silver, gr. 20 to 40 to the ounce % 

locally applied, may abort, 337 
Poultices to assist maturation, 338 
Prescriptions for tonics, in cold abscess, 338 
Sulphide of calcium, useful to abort, or arrest 
maturation, 338 

ACIDITY. 

Ammonia, the most active remedy in gastric 
acidity, if no acute irritation exists, 50 

Calcium, as an antacid, in all conditions, 89, 92 

Cerium oxalate, used in some cases of gastric 
acidity instead of bismuth, 111 

Carbonate of calcium, precipitated, best ant- 
acid in intestinal acidity, 90 

Bicarbonate of potassium, in form of efferves- 
cing powder, valuable in gastric acidity, 78 

Charcoal useful in some cases of "sour sto- 
mach," 105 

ACNE, 339 

Carbolic acid, may be used to touch pustules 

with, after incision, 339 
Cod-liver oil, if scrofulosis exists, 339 
Fowler's solution, often cures and prevents re- 
lapse, dose 1 to 3 drops thrice daily for a 

month or more, 339 
Green or Castile soap used in face-bath night 

and morning, followed by brisk rubbing ; 

if irritation ensues, bland application will 

relieve, 339 
Ichthyol ointment, 20 parts to 100 of lard, when 

induration is great, 175, 339 • 
Mercurial ointment, to relieve induration, 

several days intervening between its use 

and that of sulphur, 340 
Phosphorus, especially useful in acne indurata, 

249 



598 



INDEX OF DISEASES AND REMEDIES. 



Resorein ointment, gr. 10 to 20 to the ounce of 
lard, when induration is great, 339 

Saline purges, followed by cascara sagrada or 
similar remedy, to regulate bowels, if de 
pendent upon obstinate constipation, 339 

Sulphide of calcium, gr. 1-10 to 1-8 thrice daily 
in pustular forms, 339 

Sulphur internally and as a wash or ointment 
for women with disordered menstruation, 
prescription for, 339 

ADENITIS, 340 

Dissection of gland, if enlargement is scrofu- 
lous, 340 

Iodine ointment and lard, equal parts, applied 
by inunction, night and morning, or tinc- 
ture, as a paint, stopping on appearance of 
redness or fluctuation, 340 

Iron, syrup of the iodide, gtt. 5 to 10, in chil- 
dren. 340 

Poultice, when redness or fluctuation appears 
340 

Sulphides, 277 

ALBUMINURIA. (See Bright's 
Disease.) 

Gallic acid, if due to atony of kidneys. 159 

ALCOHOLISM. (See Poisoning from 
Alcohol.) 

ALOPECIA. (See Baldness.) 

AMBLYOPIA AND AMAUROSIS, 

341 

Bromide of potassium, 342 

Cauterization of nape of neck, 341 

Correction of optical errors, when arising from j 

congenital trouble or non-use of eyes, 341 
Cups, wet and dry, 341 
Digitalis, 341 

Electricity, constant current, 341 
Emmenagogues, if due to menstrual disorders, 

341 
Fly-blister to temple in some cases, 341 
Iodide of potassium, 341 
Mercury, when due to syphilis, 341 
Metallo-therapy, may be tried in hysterical 

cases, 341 
Nitrite of amyL inhalations, 341 
Nitroglycerin, 342 

Nux vomica, in ascending doses, 230 
Pilocarpin in urgemic amaurosis, also useful 

when due to tobacco and alcohol, 194, 341 
Seton, introduced into nape of neck, 341 
Salicylates, 342 
Strychnine, hypodermically after irritation 

has subsided, 342 

AMENORRHCEA, 343 

Aloes, as a specific, when dependent upon 
atony of sexual system or anaemia, 45 

Apiol, 2 to 3 minims thrice daily for a week be- 
fore date of menstruation, 64, 343 

Arnica, 65 

Binoxide of manganese, gr. 1 to 3, taken for 
two weeks before time of menstruation, 
206, 343 



Cantharides, as a stimulant when uterine mu- 
cous membrane is atonic, 98 
Oimicifuga, fluid extract, gtt. 30, at the proper 

time for a flow, 125, 343 
Dewees's emmenagogue mixture, 343 
Eupatorium, in hot infusion, if due to cold, 158 
Goodell's prescription for, 342 
Griffith's pills, largely used when dependent 

upon anaemia, 178 
Hot sitz-bath, for several nights before period, 

mustard added often increases its efficacy, 

343 
Iron and myrrh, a standard remedy if due to 

atony or antenna, 
Oil of rue, gtt. 5, in capsule, thrice daily, 343 
Potassium permanganate, useful but inferior 

to binoxide of manganese, 343 
Savin, gtt. 5, thrice daily, to stimulate uterus, 

in capsule, 265, 343 
Tansy, gtt, 5, thrice daily, in capsule, 285, 343 

ANAEMIA, 343 

Arsenic, alone or combined with iron, valua- 
ble, not to exceed gr. 1-6 daily, 67, 345 

Bitters, simple or aromatic, in conjunction 
with iron, when stomach and intestines 
are atonic, 344 

Blaud's pill, 344 

Bromide of iron, useful when there is chorea, 
218 

Bullock's blood, fresh or dried, given by enema 
when iron fails, 345 

Chloride of iron, useful because of its tonic 
properties, 177 

Diet and hygiene, 345 

Hypophosphites and phosphate of lime, with 
cod-liver oil, iron, and quinine, when anae- 
mia is due to childbea ring and lactation. 
91, 344 

Iodide of iron, syrup of, largely used in stru- 
mous and scrofulous anaemias, 178 

Mercury, bichloride or calomel, especially val- 
uable in syphilitic cases. Inunctions of 
mercurial ointment, once a day or every 
other day, of service in all forms of anae- 
mias, 215, 345 

Quinine in malarial cases, and in tonic doses 
in all other anaemias, 344 

Reduced iron, with laxatives and mineral 
acids for their effects on intestines and 
liver, in uncomplicated cases, 344 

Sulphate of iron or some other astringent prep- 
aration in conjunction with mild purges, 
when tongue is broad, flabby, and white, 
344 

ANAL FISSURE, 346 

Carbolic acid, 1 drop applied to spot to effect 
cure, when haemorrhoids are present a lo- 
tion of tannic acid, glycerin, and water 
also, 346 

Castor oil to relieve bowels if sulphur cannot 
be used, 346 

Flexile collodion painted over spot, may re- 
lieve, 346 

Iodoform suppositories, gr. 2 to 5, relieves pain 
of defecation, % gr. of belladonna to be 



INDEX OF DISEASES AND REMEDIES. 



599 



added when there is spasm of sphincter. 
190, 346 

Potassium hromide solution. V/ 2 drachm to 
the ounce of glycerin, locally applied by 
means of a brush to fissure, highly recom- 
mended, 346 

Sulphur, teaspoonful at night to render pas- 
sages soft, 346 

ANEURISM, 346 

Aconite, inferior to veratrum viride to quiet 
heart, 347 

Chloroform inhalation if dyspnoea is great, 347 

Digitalis, contra-indicated. 347 

Iodide of potassium, in large doses, combined 
■with restricted diet : more valuable in 
syphilitic than other forms of the disease, 
183, 347 

Morphine, gr. 1-8, combined -with croton chlo- 
ral, gr. 10. in sleeplessness, due to pain, 347 

Veratrum viride, used with great care to de- 
crease arterial pressure and prevent rup- 
ture, 394 

ANGINA PECTORIS, 347 

Alcohol, instead of nitrites, when there is vas- 
cular relaxation. 348 

Antipyrine, gr. 20, valuable in some cases, 348 

Arsenic, in full dose long continued, and elimi- 
nation of causes of nerve storm, necessary 
to effect cure, 34s 

Digitalis, when heart is weak, 348 

Ether, hypodermically, often of service during 
attack , in 1 drachm doses to nervous fe- 
males, often aborts, 348 

Hoffmann's anodyne, often the best remedy, 
168, 348 

Morphine, gr. % to y 2 , hypodermically, when . 
nitrite of amyl fails to relieve, 348 

Nitrite of amyl. inhalation of a few drops from 
handkerchief during attack, or 1 drop of a 
1 per cent, solution by mouth, .54, 348 

Nitrite of sodium or potassium, useless unless 
arterial tension is high and heart throb- 
bing, dose, gr. 3, thrice daily, 226, 34S 

Nitro-glycerin, largely given. 226 

Phosphorus, gr. 1-100, after meals, often of 
value, 348 

Stomach-pump may be required when due to 
overloaded stomach, 348 

Tonics combined with careful diet and hygiene I 
necessary to a cure, 348 



ANOREXIA, 349 

Bitter tonics, to improve appetite : contra -indi- 
cated if irritation is present, 349 

Calomel useful when following acute disease : 
nitro-muriatic acid, however, generally 
preferable, 213 

Capsicum, in convalescence, acts most favor- 
ably, 100 

Chimaphila, in dropsical patients, as a tonic 
and diuretic, 112 

Gentian, 162 

Prescriptions for tonics. 349 

Quassia, especially valuable when following 
malarial fever, 253 



APHTHOUS STOMATITIS, 349 

Borax as a mouth-wash, prescription for, 350 

Bromide of potassium or sodium, gr. 1 to 3, 
thrice daily, when nervous irritability is 
excessive, 350 

Carbolic acid as a mouth wash, 103 

Cocaine, locally applied, if spot is to be cauter- 
ized, 133 

Nitrate of silver ; stick touched to sore spots 
when they fail to yield to other treatment, 
350 

Nitric acid, gtt. 3 in water, taken through 
tube, 225 

Nitro-muriatic acid, indicated when hepatic 
torpor exists, 350 

Prescription for, 349 

Salicylic acid (1 to 250), as a mouth-wash, after 
blisters have broken, to allay pain, 260 

Salines or rhubarb, if constipation exists, 350 

Sozoiodol (5 per cent, solution), locally ap- 
plied, 271 

Sweet spirit of nitre, 10 drops, well diluted, to 
a one- or two-year-old child, and a warm 
foot-bath before retiring, to produce rest, 
350 

Tonics and careful diet after the attack, 350 

APOPLEXY, 350 

Belladonna, hypodermically, if respiration 

fails, 351 
Croton-oil as a depletant cathartic ; dose, 1 drop 

on tongue, 351 
Elaterium, gr. 1-6, as a depletant cathartic, 351 
Iodide of potassium, in large doses several days 

after attack, when clot has firmly formed, 

to promote absorption, 361 
Massage and electricity applied to muscles to 

prevent atrophy ; contra-indicated if in- 
flammation exist, 351 
Mercury, 351 
Mustard plaster to feet, or mustard foot-bath 

and ice to head, keeping head high and 

feet Ioav, 350 
Opium and calomel, % grain of each every 

four hours, if meningitis arises, 351 
Strychnine hypodermically if respiration fail ; 

also useful to stimulate trophic centres of 

cord, 351 
Venesection, if patient is full-blooded, to pre- 
vent inflammation and further leakage, 

327, 350 
A'eratrum viride or aconite, when venesection 

is impossible, to lower blood-pressure, 350 

ARGYRIA. 

Iodide of potassium may improve color of 
skin, 222 

ARTHRITIS. 

Bicarbonate of sodium, applied to part on lint 
to allay pain, 78 

Lithium, carbonate and citrate, prevents de- 
posit in joints from rheumatoid arthritis, 
203 

Mustard plaster, as a counter-irritant, 219 

Vera trine ointment, locally applied to rheu- 
matic joints, 292 



600 



INDEX OF DISEASES AND REMEDIES. 



ASCARIS LUMBRICOIDES. (See 
Worms.) 

ASCITES. (See Dropsy.) 

ASPHYXIA, 352 

Ammonia, intravenously injected into leg, to 

stimulate heart and respiration, 353 
Artificial respiration, Sylvester's method, 353 
Electricity, only to he used as a peripheral irri- 
tant to restore respiration, 352 
Oxygen inhalations, 239 
Rules regarding position of patient, 353 
Water, cold and hot alternately dashed over 
body, to stimulate respiration. 353 

ASTHMA, 354 

Aconite, in early stages, 37 

Arsenic, internally or smoked in cigarettes, 
best remedy when mucous membrane is 
at fault, 68, 356 

Belladonna, combined with morphine, very 
useful, 75 

Bromide of potassium or sodium, 30 grains 
half an hour before retiring, 356 

Cannabis indica, sometimes of service, 97 

Coffee, a cup of strong black, during parox- 
ysm. 89 

Chloral, rarely useful ; if pushed, dangerous, 
114 

Chloroform, liniment applied to chest prevents, 
inhaled, carefully, relaxes spasm, 123, 355 

Diet and hygiene, 356 

Gelsemium, 161 

Grindelia, fluid extract of, gtt. 20 to 60 drops, 
or leaves soaked in nitre smoked as cigar- 
ettes, or fumes of burning leaves inhaled, 
exceedingly useful, 165 

Iodide of potassium, useful in bronchial type, 
harmful if it is gastric, 183 

Lobelia, tincture, gtt. 10 every four hours, 
attack threatens, where spasm is present, 
in emetic dose, if heart is strong, 356 

Morphine, hypodermically, gr. % to %, alone 
or combined with atropine. 355 

Nitrate of potassium, alone or combined with 
belladonna, in cigarettes or inhalations of 
fumes, often relieves, 221, 355 

Nitrite of amyl, 3 to 6 drops on handkerchief, 
inhaled with care relieves spasm, 355 . 

Nitro-glycerin, serviceable if bronchial 
mucous membranes are engorged, 226 

Oil of amber, 48 

Oxygen, inhalations when cyanosis is ex- 
treme, 356 

Physostigma, in bronchial asthma, to aid in 
expelling mucus, 250 

Prescription for, 239 

Tobacco smoking often efficacious to patients 
not accustomed to it, 356 

ATONY, DIGESTIVE. 

Calumba, valuable in gastro-intestinal atony 

following fevers, 91 
Capsicum, one of the best remedies in atonic 

stomach, due to debility and alcoholism, 

99 



Cardamom, witb bitter tonic and mineral acid 
in atonic stomach and intestines, prescrip- 
tion for, 107 

Chimaphila, useful as a stimulating diuretic 
in atonic renal conditions, 111 

Hydrastis indicated in atony of mucous mem- 
branes, 170 

Lime salts useful in atony of mucous mem- 
branes, 91 

Pepper, in atony of genito-urinary mucous 
membranes, 242 

Physostigma, in intestinal and vesical atonv. 
250 

Strychnine, in intestinal atony, 230 

BALANITIS AND BAL ANO- 
POSTHITIS, 446 

Astringent solutions, to cleanse parts, zinc 
chloride (grs. 4 to the ounce), boric acid 
(1 per cent.), carbolic acid (1.5 per cent.) ; 
silver nitrate (gr. 1 to the ounce) especially 
valuable, 446 

Lead-water, dilute, as a wet dressing, preceded 
by astringent washes, in phimosis : if 
inflammation increases, circumcise, 446 

Silver nitrate stick, touched to ulcerations, 
446 

Tannin or zinc oxide, as a dusting powder, 
after retracting prepuce and cleansing 
parts, followed by returning prepuce over 
absorbent cotton, 446 

BALDNESS. 

Pilocarpin, locally applied, often stimulates 
new growth, too nmeh causes small pus- 
tules around follicles, prescription for, 194 

BED-SORES, 356 

Aloes, glycerole of, as local application, 45 
Alum, with spirit of camphor and white of 

egg, locally applied, to prevent, 357 
Bichloride Of mercury, solution (1 to 5000) as 

antiseptic wash, followed by dusting with 

iodoform, 357 
Catechu, with lead acetate, locally applied, to 

prevent, 357 
Glycerin, application daily, after washing and 

rubbing part, 165 
Incision, followed by irrigation, if sores tend 

to burrow, 357 
Salt and whiskey, to harden skin (drachms 2 

to the pint), 351 
Nitrate of silver (grs. 20 to the ounce), painted 

over threatening part, to abort. If ulcers 

form and are- sluggish, same solution may 

be used, 224, 357 
Soap plaster, applied to sore after washing 

with bichloride solution (1 to 5000) and 

dusting with iodoform, 357 
Supportive measures and increased amount of 

food if sloughs are large, 357 
Zinc ointment, on squares of lint, sometimes 

used in lieu of soap plaster, 357 

BILIOUSNESS. 

Aconite, antagonizes the poisonous alkaloids 
causing slow pulse, hi^h arterial tension, 
etc., 360 ■ 



INDEX OF DISEASES AND REMEDIES 



601 



Ammonium chloride, grs. 5, thrice daily, if 
due to catarrh. 360 

Bromides and chloral if nervousness and irri- 
tation are present, 360 

Calomel, gr. 1 in 6 powders, followed in four 
hours by a saline, if stools are light. 213, 
359 

Ohirata, grs. 5, in hepatic torpor, 360 

Diet. 360 

Euonymus, extract of, dose 3 grs., 360 

Ipecac, powdered, 30 grs., or apomorphine, l-."> 
gr. hypodermically, may relieve in first 
stage, 359 

Mustard plaster or cup to nape of neck, if face 
is flushed, foot-bath also of service, 360 

Nitro-muriatic acid, gtt. 3, thrice daily, of great 
service, 227, 360 

Opium, antagonizes the poisonous alkaloid 
causing hot skin, rapid pulse, dilated 
pupils, etc., 360 

Podophyllin, gr. %, if stools are dark, 213, 359 

Protiodide of mercury, 1-60 to 1-40 gr. in tritu- 
ration, thrice daily, if due to catarrh, 360 

Salines, if attack is sudden, to sweep out poi- 
sonous matter, 359 

Stillingia, fluid extract of, dose 20 drops, 360 

BLEPHARITIS. 

Boracic acid lotion when there is accompany- 
ing conjunctivitis, 361 

Chloral, 5 per cent, solution, to remove scabs 
and crusts, 361 

Creolin, 1 to 2 per cent, solution, useful as a 
wash, 143 

Ointments, dilute citrine, Pagenstecher's (yel- 
low oxide of mercury, 1 gr. : vaseline, 1 
drachm), pyrogallic acid, milk of sulphur 
(3 per cent.), locally applied after removal 
of crusts, 361 

Silver nitrate, touched to crater-like abscesses 
gives good results, 361 

Sodium bicarbonate or borate, solution (8 grs. 
to ounce), to remove scabs and crusts, 361 

BOILS. 

Belladonna, locally applied to relieve pain and 
inflammation, 361 

Calcium sulphide, hastens pointing and pre- 
vents formation of new ones ; useless in 
boils of diabetes, 361 

Camphorated alcohol, applied over boils in 
formative stage, then wiped dry, followed 
by camphorated oil, to abort, 94, 362 

Carbolic acid, 2 per cent, strength injected into 
apex of boil when formation is assured, to 
abort, 362 

Chloride of lime, added to poultice, hastens 
maturation, 90 

Collodion painted over inflamed spot, to abort, 
if pus forms it may be absorbed, if not, 
evacuate. 13S, 361 

Opium, locally applied to relieve pain and in- 
flammation, 361 

Phosphorus, 24S 

Poultices, containing sweet oil and laudanum, 
to assist maturation. 362 

Prescription for ointment. 362 



Silver nitrate (grs. 20 to the ounce), painted 
over part, may aboit, 224, 361 

BREATH, FGETID. 
Camphor, as a mouth-wash, 94 

BREASTS, INFLAMED, 362 

Aconite or veratrum viride, to depress circula- 
tion, 76, 362 

Belladonna, internally or as an ointment, be- 
fore and after inflammation, with sponge 
compresses to breast, 362 

Breast-pump, if milk persists in forming. 362 

Purges, mild and saline, 362 

BONE DISEASE. 

Iodine ointment, diluted 34, or tincture, locally 
applied, 186 

BRIGHT'S DISEASE, ACUTE, 362 

Aconite, to depress circulation, 362 

Bromides and opium, given cautiously, if 
aconite fails to quiet restlessness, 362 

Cannabis indica, if hematuria is present, also 
to allay pain over kidneys, 97, 362 

Cantharides, x / 2 drop doses of tincture, about 
fifth day, when kidneys are atonic, also if 
hsematuria is present, 98, 363 

Citrate of potassium, to increase flow of urine, 
363 

Cups or leeches, over loins if urine is scanty, 
362 

Digitalis, with squill or calomel, gradually in- 
creased, followed by gin or compound 
spirit of juniper in later stages, 363 

Elaterium, to relieve dropsy, 363 

Flaxseed tea, as a demulcent, 159 

Gallic acid and ergot, to control excessive 
hematuria, 365 

Iron, also to decrease albuminuria, if anaemia 
is present, 177, 363 

Juniper, to reestablish secretion, after inflam- 
mation has subsided, 195 

Pilocarpine hydrochlorate, gr. 1-8 to 1-20, hypo- 
dermically, if uraemia threatens, repeated 
in fifteen minutes if no sweat appears, 194, 
363 

Potassium bitartrate, 79 

Sweet spirit of nitre, to increase flow of urine, 
363 

Turkish bath, to aid in eliminating effete pro- 
ducts, used with care, 323 

BRIGHT'S DISEASE, CHRONIC.363 

Cannabis indica, to allay pain over kidneys, 
also if hsematuria is present. 97 

Cantharides, particularly useful if due to alco- 
holism, 98 

Capsicum, to check albuminuria, 363 

Chloride of gold or sodium has been recom- 
mended in interstitial forms, 364 

Chloride of iron, if anaemia is present : also to 
decrease albuminuria, 177, 364 

Digitalis, to decrease albuminuria, 363 

Elaterium. to relieve dropsy, 364 

Jalap, to relieve dropsy, 364 



602 



INDEX OF DISEASES AND REMEDIES. 



Lithium, carbonate or citrate, gr. 5, thrice 

daily, said to be useful in gouty cases, 364 
Milk diet, 363 
Oxygen inhalations, 364 
Potassium acetate or bitartrate, alone, or, 

better, with gin or compound infusion of 

juniper, 79, 363 
Potassium iodide, gr. 5, thrice daily, used with 

great care, 183 
Sodium arsenite, gr. 1-20, in gouty cases, 364 
Squill, to decrease albuminuria, 263 
Turkish and Russian baths, relieve dropsy b ; 

increasing action of skin, 323, 364 

BEOMIDEOSIS. 

Belladonna, 75 
Borax of great value, 80 

Salicylic acid, used as a dusting powder, pre- 
scription for, 261 

BRONCHITIS, 364 

Aconite, to depress circulation in initial 
stage, 37, 365 

Ammoniac, useful in old forms devoid of in- 
flammation, 53 

Amber, oil of, and olive oil (1 to 3), applied to 
back and front of chest, in infantile bron- 
chitis, 48 

Ammonium carbonate, alone or with the chlo- 
ride, especially useful in children ; 2 to 10 
gr. in syrup of acacia, 52 

Ammonium chloride, with other remedies, in 
second stage, to stimulate bronchial tubes, 
prescription for ; it may be applied alone 
in solution with atomizer, 367 

Antimony, to decrease inflammation of first 
stage ; only to be used when patient is 
strong and sthenic, 365 

Apomorphine, gr. 1-10 to 1-5, as an expectorant 
in subacute stage ; if exudation accumu- 
lates rapidly, gr. 1-20 to 1-10 hypodermically, 
as an emetic, 368, 369 

Asafcetida as a stimulating expectorant, 71 

Astringent sprays, often of value if secretion is 
excessive : tannic acid (2 to 3 gr. to the 
ounce), alum solution (a few grains to 
saturation), Monsel's solution (10 to 15 
drops to the ounce), lead acetate (1 to 5 gr. 
to the ounce), 369 

Balsam of Peru, or tolu, with other drugs, to 
decrease secretion in chronic stage, 368 

Belladonna, to check excessive secretion and 
stimulate respiration, 369 

Benzoic acid, 78 

Caffeine, to stimulate respiration if suffocation 
threatens, 369 

Camphor, in old or atonic cases, 94 

Codeine, recommended when cough is exces- 
sive, 137 

Creasote, recommended in chronic bronchitis, 
144 

Croton oil and sweet oil (half and half), some- 
times applied to chest, 144 

Cubebs or copaiba, as expectorants, liable to 
derange stomach, 368 

Digitalis, if heart is feeble, 369 



Dry cups, mustard, or spice plaster, applied on 
each side of the vertebrae, at sixth rib, may 
relieve congestion, 365 

Eucalyptus oil, valuable in later stages ; dose, 
1 to 5 gr. in capsule every three hours, 368 

Flax-seed tea, a useful demulcent, 159 

Garlic, in later stages, boiled in milk or as a 
poultice, 367 

Grindelia, very useful in later stages, 165 

Gurjun oil, when a powerful expectorant is 
desired, 166 

Ipecac, to promote secretion in first stage, also 
as an emetic when exudation accumulates 
rapidly and suffocation threatens, 191, 369 

Iodide of potassium, often useful when ammo- 
nium fails, contra- indicated if secretion is 
excessive, 183 

Morphine, to quiet excessive cough : dose, 1-24 
to 1-12 gr., 366 

Myrrh, with expectorant mixtures, useful in 
later stages, 220 

Mustard foot-bath, with drinks of hot whiskey 
or brandy, in early stages, 365 

Oxygen inhalations, with astringent sprays, 
when dyspnoea is great, 239, 369 

Physostigma, in old persons with dilated tubes, 
as an expectorant and tonic to muscular 
fibres of tubes, 369 

Pilocarpin, to produce copious perspiration 
when patient is strong; nausea may be 
produced, 365 

Pitch, 365 

.Potassium citrate with ipecac, to aid in forma- 
tion of secretion, prescription for, 366 

Prescription for excessive cough, 145 

Quinine, if fever is persistent, 366 

Resin, inhalations of fumes, said to be useful 
in chronic types, 254 

Sandalwood oil, in later stages , dose, 5 to 10 
minims, 262, 368 

Sanguinaria, 263 

Senega, a stimulating expectorant in subacute 
and chronic stages, 268 

Squill, inferior to other, drugs as an expec- 
torant, 368 

Steam inhalations, 365 

Strychnine, to stimulate respiration, if suffo- 
cation threatens, 369 

Tartar emetic, as an expectorant, gr. 1-60 
hourly, or 1 drachm of solution (gr. 2 to 
the pint), or as an emetic in sthenic cases, 
58 

Terebene, if ammonium chloride fails ; dose, 5 
to 10 minims in capsule or emulsion ; must 
be stopped if kidneys or stomach are irri- 
tated, 368 

Turpentine, inhalations or applied to chest, 
diluted one-half with sweet oil for chil- 
dren, 289 

Veratrum vriide, less severe than pilocarpine 
in first stage ; dose, 2 to 3 drops of tincture, 
365 

Water, hot and cold dashes, if death is immi- 
nent from suffocation, 369 

BRONCHOCELE. 

Potassium iodide internally, and tincture of 

iodine externally, best treatment, 184 



INDEX OF DISEASES AND REMEDIES 



603 



BEONCHOREHCEA. 
Alum, applied in fine spray : solution, grs. 20 

to the ounce, 47 
Gallic acid, 159 

BEUISES. 

Arnica, 65 

Liquor plumbi subacetatis, locally applied : 
strength, 1 to 4 ounces to the pint, contra- 
indicated, if skin is broken ; also useful as 
lead-water and laudanum (water 14, lead- 
water 7, laudanum 1), 200 

BUBO. 

Carbolic acid, 10 minim injections (gr. 8 to the 
ounce), preceded by ether spray, 104 

Iodine, painted around spot with compresses 
and spica bandage, or wet bag over swelling, 
373 

Incision, at first sign of suppuration, followed 
by washing with bichloride solution (1 to 
1000), hydrogen peroxide {% strength), or 
zinc chloride (grs. 40 to water ounce 1), 
373 

BUENS AND SCALDS, 370 

Boracic acid, solution a useful dressing, 80. 
370 

Calcium carbonate, precipitated, as a dressing, 
90 

Cantharides, tincture of (1 to 40), locally 
applied if burn is not diffuse, 370 

Carbolized sweet oil, cosmoline or simple 
cerate, useful application to counter-irri- 
tation, burns, 317 

Ceratrum resinse, as local application, 254 

Cold cream, as a dressing, 256 

Digitalis, in shock, if circulation fails to re- 
spond to less powerful stimulants. 370 

Ichthyol ointment, 175 

Lead carbonate, as an ointment, or with oil, as 
a dressing, 201 

Lime-water and linseed oil, equal parts, the 
best dressing. Carbolic acid is of service, 
added in proportion of 1 to 20, 159, 370 

Morphine and atropine, % to % gr. of former 
to 1-60 gr. of latter, to allay pain, 370 

Opium, to relieve pain, 235 

Sodium carbonate, solution often relieves pain 
370 

Potassium citrate with sweet spirit of nitre, if 
urine is high-colored, 371 

Poultice, applied to counter-irritation blister, 
relieves pain ; when formed, puncture if 
large, allow to break if small, dress . ith 
absorbent cotton, 318 

Stimulants, if shock is severe, 370 

Zinc oxide, 239 

CAMPHOR-HABIT. 

Camphor monobromate, 95 

CANCER. 

Arsenic, small doses often repeated, to relieve 
vomiting and pain in gastric cancer, 68 



CANCRUM ORIS. 

Arsenic internally, 68 

Boracic acid, as a mouth-wash, 80 

CARBUNCLE. 

Carbolic acid, solution (grs. 8 to the ounce), 

hypodermic injections, to abort, 104 
Phosphorus, 248 

CARIES. 

Lime salts, especially valuable in dental caries 
of nursing women, 91 

CATARRH OF AIR-PASSAGES. 

(See Nasal Catakkh.) 

Alum, applied in fine spray (grs. 20 to the 
ounce), 47 

Arsenic, internally, 68 

Camphor, of service in old or atonic cases, 93 

Sozoiodol, applied locally in 5 per cent, solu- 
tion, 271 

CATARRH OF BLADDER. 

Ammonium benzoate, to render urine acid, 50 
Juniper, a valuable stimulant, 195 

CATARRH OF UTERUS. 

Hydrastis, 170 

Sozoiodol, in powder, applied by tampon in 
catarrh of cervix uteri, 272 

CEREBRAL DISEASES. 

Blisters, to nape of neck in cerebritis, 316 
Croton oil, in cerebral congestion, 144 
Elaterium, in cerebral congestion, 150 
Phosphorus, often of service in cerebral soften- 
ing, 249 . 
Veratrum viride, of greatest value in cerebritis 
during stage of hypereemia.after that period 
harmful, 294 

CHANCRE. 

Nitric acid, used as a caustic, surrounding 
tissues being protected by oils, 225 

CHANCROID, 371 

Actual cautery, the most destructive caustic, 
371 

Bismuth and zinc oxide, or calomel and bis- 
muth, may be substituted for iodoform as a 
dusting powder, 372 

Carbolic acid, as a wet dressing (grs. 5 to water 
oz. 1), 372 

Cocaine, 20 per cent, solution, to relieve pain of 
cauterization, 371 

Hot sitz-bath, 372 

Iodoform, the best dusting powder after cau- 
terizing, also as a palliative treatment in 
erosive types preceded by nitric acid wash 
(dr. 1 to water Oj), 371, 372 

Iodol, as a substitute for iodoform, 372 

Nitric acid, a good caustic, surrounding tissue 
being protected by oil, 225, 371 

Opium, after cauterizing, 372 

Sulphuric acid with charcoal, a good caustic 
and after-dressine, 371 



604 



INDEX OF DISEASES AND REMEDIES. 



Tannin, combined with dusting powder (1 to 
4), if discharge is profuse, 372 

CHAPPING. 

Calcium carbonate, precipitated, as a local 

protective in intertrigo of infants, 89 
Camphor, useful, added to precipitated calcium 

carbonate, in intertrigo, 94 
Cold cream, a useful application, 256 
Light magnesia, as a dusting powder in inter- 
trigo, 205 
Lycopodium, as a dusting powder, 204 
Zinc oxide, in powder form, useful in inter- 
trigo, 239 

CHILBLAINS. 

Alum, as a wash, 47 

Capsicum, tincture painted over parts or ap- 
plied as a paper, prescription for, 100 

Ceratum resinee, 254 

Ichthyol ointment, 175 

Iodine ointment and lard, equal parts, gives 
great relief, 187 

CHOLERA, ASIATIC, 373 

Chloroform, gtt. 3 to 5 hourlv, of great service, 
373 

Cocaine in small dose and turpentine stupe 
to belly, to control vomiting, 374 

Fly blister, over vagi, beneath jaw, highly re- 
commended, 374 

Friction of body and hot broths, give comfort, 
374 

Morphine, bypodermically, if laudanum can- 
not be taken by mouth, 373 

Quarantine and strict hygiene, as a prophy- 
lactic, 373 

Sulphuric acid, alone or with laudanum and 
camphor, to control diarrhoea, 373 

Water, with tribasic phosphate of lime and 
potassium chloride added, as a drink, or 
intravenously, 374 

CHOLERA INFANTUM, 374 

Arsenic, to check vomiting, prescription for, 

376 
Brandy, if vomiting is active and collapse 

threatens, a few drops in drachm of nour- 
ishment, 375 
Castor oil, with paregoric, to clean out bowels 

and allay irritation, 375 
Cold drinks, pieces of ice and antipyretics, if 

rectal temperature is above normal, 374 
Hot drinks, applications and baths if rectal 

temperature is sub-normal, temperature 

being watched, 375 
Laudanum, gtt. 10. starch-water, drachm 3, by 

enema, and calomel gr. % or gray powder 

gr. % by mouth, to control vomiting and 

purging, if severe, 376 
Mustard or spice plaster, over belly, always 

useful, 376 
Prescriptions for, 375, 376 
Predigested milk, the best food, 375 



CHOLERA MORBUS. 

Camphor, 93 

Castor oil. with laudanum, to sweep out intes- 
tines, before diarrhoea mixture is used, 376 

Ipecac, gr. 3 every two hours, often of service, 
191 

Mustard or capsicum plaster, over abdomen, 
376 

Prescription for, 376 

CHLOROSIS. (See Anemia.) 
CHORDEE. 

Aconite, often relieves, 37 

Belladonna internally and ointment applied 
to under surface of penis, 75 . 

Camphor with bromides, very useful in some 
cases, 93 

Cantharides, gtt. 1, thrice daily, 98 

Hot sitz-batli and steeping penis in hot water 
before retiring relieves, 321 

Morphine hypodermically, gr. %, with atro- 
pine gr. 1-60 into perineum, to relieve, 442 

Opium or belladonna suppositories, to relieve, 
442 

CHOREA, 377 

Arsenic, in ascending doses, discontinued if 
symptoms of poisoning ensue, 377 

Bromides with chloral, when there is insom- 
nia, prescription for, 378 

Chloral, 114 

Cimicifuga alone, or with iron, very useful, 
125, 377 

Chloroform inhalations when excessive, 122 

Hot pack, at bed time if there is insomnia, 377 

Monobromated camphor, 95 

Nitroglycerin, 226 

Salicylates or iodides of value, if associated 
with rheumatism, 377 

Silver oxide and nitrate, occasionally used, not 
reliable, 378 

CINCHONISM. 

Potassium bromide, as a preventive, 85 

CIRRHOSIS OF LIVER. (See Hepatic 

Cirrhosis.) 

COLDS. (SeeCoRYZA.) 

COLIC. 

Asafoetida, useful in children, 71 

Chloral and bromide, when severe in children, 
prescription for, 242 

Ether internally, very useful, 156 

Hoffmann's anodyne, 168 

Hyoscyamus, 173 

Matricaria, infusion, to prevent, in teething- 
children, 207 

Mustard plaster, y± to y 2 strength for tender 
skin, 219 

Rue, as a carminative, 257 

COLIC, HEPATIC, 378 

Belladonna, in full dose, to relax spasm, 75 
Chloroform or ether, inhalations to relieve pain 
during spasm, 378 



INDEX OF DISEASES AND REMEDIES. 



605 



Hot applications over liver, as a relaxant. 378 

Morphine, gr. % or y 2 with atropine gr. 1-60 
hypodermically, to relieve pain, 378 

Olive or cotton-seed oil, 1%, pint during attack, 
ether drachm 1, may be added with advan- 
tage, 378 

Opium with belladonna, to relieve pain and 
spasm, 235 

COLIC, RENAL. 

Belladonna, in full dose, 75 

Chloroform, a few inhalations often relieve, 

123 
Opium with belladonna relieves spasm and 

pain, 235 

COLLAPSE. 

Amyl nitrite, 54 
Digitalis, 148 

Ether, by mouth, inhalations, or hypodermi- 
cally of great service, 156 

CONDYLOMATA. 

Calomel, as a dusting powder, often removes, 

213 

CONGESTION. 
Digitalis, relieves stasis of congested lung, 148, 
Croton oil, in cerebral congestion, 144 
Elaterium, in cerebral congestion, 150 
Ergot of service, especially with digitalis, in 

pulmonary congestion, 151 
Glycerin, on cotton tampon, as a depletant in 

uterine congestion, 165 
Juniper, often relieves congested kidneys, 195 

CONJUNCTIVA, BURNS OF, 379 

Atropine incorporated with liquid vaseline in- 
stilled, to prevent iritis, 379 

Cod-liver oil, instilled after removal of foreign 
matter, 379 

Gold-beater's skin and breaking up granula- 
tions to prevent corneal inflammation, 379 

Neutralization of foreign matter, if acid or 
alkaline, 379 

CONJUNCTIVA, CHEMOSIS OF, 380 

Astringent washes, especially alum, 380 
Nicking swollen tissue with scissors, -380 
Warm moist compresses, 380 

CONJUNCTIVA, HEMORRHAGE 

BENEATH, 380 

Boracic acid or cocaine wash, when conjunc- 
tival irritation exists, 380 

Massage of globe through closed lid. to aid ab- 
sorption of blood, 380 

CONJUNCTIVA, XEROSIS OF, 3S2 
Glycerin, almond or cod-liver oil or weak alka- 
line washes, 3S2 

CONJUNCTIVITIS, CHRONIC. 

Boracic acid, wash (gr. 10 to the ounce), co- 
caine, gr. 2, may be added if there is no 
corneal ulcer, for this condition salt, gr. 4, 
may be substituted, 379 



Copper, crystal applied to diseased spot, if sub- 
acute, or a solution (gr. 1 to 3 to the ounce), 
143 

Correction of refraction error, if it exists, 379 

Eye wash, to allay irritation, prescription for, 
so 

Lapis divinus. 379 

Tannin and glycerin (gr. 10 to the ounce), as an 
application, 379 

Zinc oxide, in powder or the sulphate in the 
form of a wash, 239, 276 

CONJUNCTIVITIS DIPHTHER- 
ITICA, 380 

Atropine, instilled, 380 

Boracic acid or bichloride solution, frequently 
applied iu early stages, 380 

Cade, oil of (strength 1 to 10), 380 

Citric acid ointment or lemon juice, locally ap- 
plied, 380 

Hot compresses, 380 

Quinine, solution (gr. 3 to the ounce), 380 

Silver nitrate, same as in purulent conjuncti- 
vitis. 380 

Sulphur, Burgomaster's insufflations, 380 

CONJUNCTIVITIS, FOLLIC- 
ULAR, 3S0 

Alum, crystal applied locally if due to atropine 

instillations, 380 
Astringent and antiseptic lotions, 380 ■ 
Calomel, as a dusting powder, alone or with 

bismuth or iodoform, 380 
Copper sulphate, as an ointment (gr. % to the 

drachm V, 380 

CONJUNCTIVITIS, LACHRY- 
MAL, 380 

Treatment same as for chronic type. 

CONJUNCTIVITIS, MUCOPURU- 
LENT, 381 

Treatment same as for purulent type. 

CONJ UNCTIVITIS, PURU- 
LENT, 381 

Alum sulphate, as ; n application, 381 

Atropine or eserine, if corneal ulcer appears, 
381 

Bichloride of mercury (1 to 7000), or boracic 
acid (saturated solution), as a wash, used 
hourly, 381 

Creolin, ointment (1 per cent.), 382 

Hot compress, in lieu of cold, if vitality of cor- 
nea is threatened, 381 

Ice compress, in early stage, to reduce inflam- 
mation, 381 

Iodoform ointment, 382 

Silver nitrate, stick or solution (gr. 10 to the 
ounce), touched to lids after cleansed of 
pus, excess neutralized with salt solution ; 
2 per cent, solution dropped in newborn 
infant's eyes to prevent, 381, 382 

Sozoiodol (2 to 30), 271 

Zinc sulphate, 382 



606 



INDEX OF DISEASES AND REMEDIES. 



CONJUNCTIVITIS, SIMPLE, 379 
Alum curd or solution (gr. 4 to the ounce), or 

application of stick, if there is chronic ten- 
dency, 47, 379 
Boracic acid, lotion (gr. 10 to the ounce), 379 
Cold compress, dipped in water, and hama- 

melis (equal parts), to allay inflammation, 

379 
Silver nitrate, solution (gr. 2 to 5 to the ounce), 

if there is muco-purulent discharge, 379 
Zinc sulphate, solution (gr. 2 to 4 to the ounce), 

alone or with boracic acid, if there is 

chronic tendency, 379 

CONSTIPATION, 382 

Aloes and podophyllin, with other drugs, con- 
tra-indicated for continued use, prescrip- 
tion for, 45, 385 

Alum, useful in some cases, 47 

Belladonna, 75 

Cascara sagrada, the best curative agent, dose 
gtt. 10 to 20 of fluid extract or 1 drachm of 
cordial, 106, 385 

Castor oil, following acute disease in children, 
ultimately harmful in all cases, 109, 385 

Colocynth, jalap, or senna, not to he used con- 
stantly, 385 

Enemata, as a routine treatment harmful, 386 

Glycerin, suppositories or enemata, often used, 
* 386 

Gymnastic movements, horseback riding, or 
massage, with regulated diet. 383 

Hunyadi, Carlsbad, or Friedrichshall waters, 
rarely of value, 384 

Manna, as a laxative fruit for adults or drachms 
1 to 2 to bottle of milk ; for infants, harm- 
ful if long continued, 307, 385 

Mercury, as a continued purge, harmful, 385 

Opium, 235, 286 

Oxygen water, before retiring, in intestinal 
atony, 240 

Phosphate of sodium, useful in rickety chil- 
dren, grs. 2 to 4 in bottle of milk ; or adult, 
grs. 30 to 60, 246, 385 

Rhubarb, usually harmful, in some cases in 
children, useful, 255, 385 

Salines, to unload bowels, not as a routine 
treatment, 384 

Seidlitz powder, 367 

Soap suppositories useful in children, 270 

Stillingia, recommended, when habitual, 274 

Sulphur, especially valuable if hemorrhoids 
are present, 279 

Tobacco, sometimes used, 287,386 

CONVULSIONS. 

Allium, as a poultice over spine in infantile 
spinal convulsions, 43 

Amyl nitrite, 54 

Chloral with bromide, in infants ; also useful 
alone in ursemic and puerperal convul- 
sions, if no acute renal trouble exists, 114 

CORNS, 386 
Fowler's solution, locally applied, 69 
Salicylic acid, the best application, formula 
for, 386 



Silver nitrate, solution (grs. 60 to the ounce), 
applied to soft corns every four or .. ve days, 
386 

CORYZA, 386 

Aconite, useful in early stages, 37 

Allium, efficient though disagreeable, in per- 
sistent colds, as a poultice to breast or in 
emulsion or boiled in milk for children, 
43 

Arsenic, taken for months, often cures persis- 
tent colds, 68 

Atropine with morphine, along with the use 
of quinine, in stages of watery secretion, 
389 

Calomel or blue pill followed by a saline, often 
does good, 389 

Camphor, as a snuff, or inhalation of spirit, or 
fumes, when sneezing and lachrymation 
are excessive, 94 

Cocaine (1 part), morphine (1 part), and bis- 
muth (7 parts), as a snuff, 133 

Cosmoline, as a spray, soothing, 390 

Cubebs, as a snuff during stage of secretion, 
145 

Ferrier's snuff, following alkaline w T ash. pre- 
scription for, 390 

Glycerin, with whiskey not very useful : ap- 
plied alone, by brush or spray, often of ser- 
vice, 164, 165 

Hot mustard foot-bath with hot draught and 
Dover's powder with rest in bed. may re- 
lieve, 389 

Prescription for wash, 389 

Prophylactic measures, 390 

Quinine, internally or in spray (grs. 1 to 2 to 
the ounce), 128, 389 

Sweet spirit of nitre, 282 

Tartar emetic, useful in moderate doses. 58 

Turkish bath in early stage, aborts ; later, re- 
lieves ; also a preventive in persons sus- 
ceptible to colds, 323, 324, 389 

Whiskey, 389 

COUGH. 

Acacia, as a mucilaginous drink with flaxseed 
and liquorice, to loosen hacking cough, 29 

Belladonna, the best remedy in nervous cough, 
75 

Almonds, essential oil, in emulsion, as a de- 
mulcent in cough of phthisis, 43 

Cannabis indica, a useful adjunct to cough 
mixtures, 96 

Chloroform, useful, added to cough mixtures 
for irritant cough, 122 

Flaxseed tea, alone or with pai-egoric, a useful 
demulcent in excessive cough, 159 

Gelsemium, 161 

Hydrocyanic acid, highly recommended, pre- 
scription for, 173 

Hyoscyamus, 173 

Iodine, as a paint, over supra-clavicular 
spaces, in irritative cough, 187 

Ipecac, in spray, useful in chronic winter 
cough, 191 

Morphine in wild cherry syrup, useful in irri- 
tative cough and when cough is greater 
than necessary to expel mucus, 235 



INDEX OF DISEASES AND REMEDIES. 



607 



CRAMPS. 

Belladonna, internally or locally as a liniment, 

75 
Chlorodyne, for stomach cramp, 123 
Ginger, especially useful in menstrual cramp 

due to cold, 163 ' (See Dysmenorrhea.) 

CROUP, MEMBRANOUS, 391 

Aconite, in early stages, 37 

Belladonna internally, accompanied by potas- 
sium chlorate, as a paint (5 to 15 grains to 
the ounce) to pharyngeal walls before 
membrane forms, 390 

Boracic acid with glycerin (1 to 30), locally ap- 
plied, to remove membranes, 390 

Corrosive sublimate, gr. 1-10 to 1-4, or calomel, 
gr. 1-6 to 1-4, hourly till it acts, followed by 
supportive measures, the best means to 
prevent or limit exudation, used only in i 
sthenic cases, 391 

Iron, tincture of chloride, externally and inter- 
nally, and ice held in mouth and applied 
to glands, if suppuration threatens, 177, 
391 

Lime-water or lactic acid solution (gr. 30 to the 
ounce), in spray, to aid in solution of mem- 
brane, 391 

Oxygen inhalatious, atropine, and strychnine, 

if suffocation threatens, 391 
Trypsin, applied by swab or spray, to digest 
membrane, 391 

CROUP, SPASMODIC, 391 

Amyl nitrite, inhalations, if paroxysm is 

severe, 392 
Belladonna, bromides, chloral, or opium in 

small doses at bedtime, as a preventive, 

392 
Cold cloth around neck, and child placed at 

ouce in hot bath, air of room being moist- 
ened by steam, 392 
Prophylactic measures, 392 
Spongio-piline or flannel, wet with hot water, 

applied to neck and covered with oil silk 

or cotton, 321 
Sanguinaria, as an emetic, unfavorable, 263 

CYSTITIS, ACUTE, 392 

Aconite in full dose, with sweet spirit of nitre 
and potassium citrate if there is fever, pre- 
scription for, 392 

Belladonna, alone or with aconite, especially 
useful if due to cold ; dose, gtt. 5 to 10 
thrice daily, 392 

Boracic acid, to render urine acid, 80 

Cannabis indica, preferable to opium for re- 
lieving pain, 393 

Creolin, as a vesical wash (1 to 2 per cent, solu- 
tion) in cystitis of women, 143 

Flaxseed tea, as a demulcent, 159 DIABETES MELLITUS, 394 

Hot compress over bladder, should not contain I Acidulated water or non-purgative alkaline 
irritants, 392 water, to allay thirst, 395 

Hygienic measures, 393 Almond bread, as a food for diabetics, 43, 333 

Hot sitz-bath and enemata, to relieve bearing- I Alum, 47 

down pain, 393 j Codeine, grs. 1 to 5, thrice daily, 395 



: Laudanum, gtt. 30, to starch-water, oz. 2, in 
enema, to relieve bearing-down pain, 392 

Quinine, contra-indicated, 393 

Opium, belladonna, or iodoform suppository, 
to allay bearing-down pain, 235, 393 

CYSTITIS, CHRONIC, 393 

Arbutin, gr. 3 to 5, or fluid extract of buchu or 
uva ursi, x / 2 to 1% drachm, to improve vesi- 
cal mucous membrane when inflammation 
is of subacute type, 394 

Benzoic or boracic acid, gr. 5 to 10 in pill, to 
render urine alkaline, 393 

Grindelia, as a vesical stimulant, 165 

Mercury bichloride solution (1 to 10,000), as an 
injection to cleanse bladder, 393 

Opium suppositories, gr. % to %, very useful, 
235 
j Potassium salts, except bitartrate, to render 
urine alkaline when mucus is excessive, 
393 

Turpentine, oil of sandalwood, cubeb, or co- 
paiba, useful when vesical atonv is great, 
394 

Silver nitrate, solution (gr. 1 to oz. 4, increased 
gradually to gr. ij to oz. j), as an injection 
when discharge ismuco-purulent, followed 
by salt solution if pain is severe, 393 

Strychnine and cantharides, when vesical 
atony is great, 394 

DEBILITY. 

Arsenic with bitter tonics, very useful, 67 
Calomel, in debility of children, often relieves, 

212 
Eupatorium, a good tonic, 158 
Lime salts, 91 
Phosphorus, of service in sexual debility, 248 

DELIRIUM TREMENS. 

Chloral, of great service used cautiously, 114 
Croton oil, 144 
Hops, 169 

Hyoscine, in insomnia, 174 
Monobromated camphor, when nervous twitch- 
ing is troublesome, 95 
Valerian with morphine, frequently used, 291 

DIABETES INSIPIDUS, 394 

Arsenic, 68 

Belladonna or opium, if due to nervous irrita- 
bility, 394 

Carbonate or citrate of lithium, grs. 10, with 
sodium arsenite, gr. 1-30, valuable in gouty 
types, 68 

Ergot, 394 

Gallic acid, alone or with opium, one of the 
best remedies, 159, 394 

Rhus aromatica, highly recommended, 255 

Strychnine and sulphate of iron, as tonics, 394 



608 



INDEX OF DISEASES AND REMEDIES 



Colchicum and iodides, in gouty types, 395 
Chloride of gold or sodium, gr. 1-10, recom 

mended, 395 
Diet, 394 

Ergot, highly recommended, 395 
Gallic acid, with opium, one of the best reme- 
dies, 159 
Glycerin or saccharin, as sweetening agents, 

" 396 
Iodol, grs. 2 to 6, thrice daily . recommended, 

190 
Iron, lactophosphates of lime and sodium, 

strychnine and astringents, if cachexia 

comes on. 396 
Lime-water, 92 
Lithium carbonate or citrate, with arsenic, 

very useful, if due to gout, 395 
Opium, gr. % to %, thrice daily, largely used, 

236, 394 
Purgatives, restricted diet and exercise, if due 

to high living and little exercise, 395 
Salicylates and iodide of potassium, if due to 

rheumatic or gouty taint, 395 

DIARRHCEA, 396 

Ammonium chloride, grs. 5, every four hours. 

best remedy in persistent catarrhal states, 

397 
Arsenic, 68 

Belladonna, may be used in serous types, 75 
Bismuth, with carbolic acid, gtt. 1 or 2, highly 

recommended in serous and summer diar- 
rhoeas, '398 
Bismuthi et ammonii citras, in chronic serous 

types, 80 
Cajuput, gtt. 10 to 20, in serous forms, 89 
Calomel, followed by a saline, useful in sthenic 

cases of summer diarrhoea, 399 
Calumba, in summer and serous diarrhoeas, 

prescription for, 91 
Camphor, useful in serous but never in mucous 

types, 93 
Castor oil, with laudanum and sodium bicar- 
bonate, to unload bowel and render it alka- 
line, 396 
Catechu, alone or with opium, in serous types, 

prescription for, 110 
Chalk mixture, with kino and catechu, in 

serous diarrhoeas, prescription for. 90 
Charcoal, useful in acid and fermentative 

types, 105 
Chirata, nitro-muriatic acid, or, better still, 

nitric acid and cardamoms, in mucous 

type, prescription for, 397 
Chloroform, with astringents and opium, very 

useful after removal of irritant cause, 123 
Chlorodyne, largely used, in serous types, 128 
Cinnamon, as a stimulant, in serous types, 129 
Cloves, 131 
Copper sulphate, gr. 1-4, with opium, gr. 1, in 

pill, or in enema (grs. 5 to 20 to the ounce 1 , 

if due to ulceration, 142 
Diet, for summer diarrhoea, 399 
Ergot, sometimes useful in serous types, 151 
Gallic acid, 159 
Geranium, 1 or 2 roots, boiled in pint of milk, 

of great service in infantile types, 162 



Ginger, a good addition to diarrhoea mixtures, 

163 
Heematoxylon, useful in children, because of 
agreeable taste, 167 

Hope's camphor mixture, in serous and chol- 
eraic types, 170 

Iron sulphate, grs. 5 in pill, in chronic types, 
177 

Kino, formula for, 196 

Krameria, useful in serous types, 196 

Lead acetate, with opium and camphor, in 
serous type, prescription for, 200 

Mercury, with chalk, or calomel, in hepatic 
disorder, 398 

Morphine, gr. 1-80 to 1-50, hypodermically, 
often checks summer diarrhoea, in chil- 
dren, 236 

Mustard plaster, or other counter-irritants, to 
abdomen, 397 

Naphthalin, 220 

Nitrate of silver and hyoscyamus, or lead ace- 
tate and opium, in mucous diarrhoea, pre- 
scription for, 397 

Nitric acid, with a bitter tonic, useful in green 
diarrhoea of children ; combined with Fair- 
child's essence of pepsin, relieves chronic 
types in children, 225 

Nitro-muriatic acid, or podophyllin, gr. 1-50 to 
1-40, in summer diarrhoea, if duodenum is 
at fault, 398 

Nutmeg, useful in prescriptions for serous 
types, 221 

Pepsin with hydrochloric acid, in summer diar- 
rhoea, if gastric process is deficient, 398 

Phosphate of sodium, lime salts, and common 
salt in summer types, if rickets is present, 
246, 398 

Raspberry leaves, used in domestic medicine,. 
257 

Rhubarb, often useful, preceding direct treat- 
ment in summer diarrhoea, 255 

Sulphuric acid, especially valuable in serous- 
types, prescription for, 398 

Tannic acid, in atonic or serous types, 283 

Tar mixture, highly recommended in obstinate 
types, formula for, 251 

Thymol, naphthalin, and especially salicylic 
acid, useful as intestinal antiseptics, in 
summer diarrhoea, 398 

Zinc oxide, in summer types, prescription for, 
239 

Zinc sulphate, 2-grain pills, useful especially 
with opium, or podophyllin, gr. 1-60, in se- 
rous types, 

DIPHTHERIA. (See Croup, 
Membranous.) 

Boracic acid, as a wash, 80 

Carbolic acid, 103 

Iodine, inhalations, 188 

Iron, tincture of the chloride, as a local appli- 
cation, 177 

Mercury bichloride, to prevent exudation, 268 

Monsel's solution, as a topical application, val- 
uable, 179 

Potassium chlorate, applied on swab, danger-- 
ous internally, 244 



INDEX OF DISEASES AND EEMEDIES 



609 



Potassium permanganate, solution (gr. 20 to 
the pint), applied as a swab, or as a gar- 
gle, 244 

DROPSY, 399 

Acupuncture, less favorable than incisions, 
only to be resorted to after other remedies 
fail', 297, 403 

Adonidin and sparteine or strophanthus, if 
other drugs fail, 403 

Aspiration, in local effusions or dropsy of he- 
patic cirrhosis, 403 

Caffeine, in torpidity of kidneys, 403 

Calomel and digitalis, in renal and cardiac i 
types, 402 

Colocynth, compound extract of, gr. 2 to 6, 139, ; 
402 

Copaiba, of service in slow renal types, 141 

Digitalis, gtt. 5 to 10, with cantharides, gtt. 1, j 
thrice daily, in renal torpidity due to heart ! 
trouble, 402 

Elaterium, especially useful in renal dropsy. 
402 

Jalap, compound powder of. gr. 20 to 30, with 
potassium bitartrate, gr. 10 added, espe- 
cially serviceable in renal dropsy, 401 

Magnesium sulphate, in concentrated solution, 
before breakfast, 205, 403 

Pilocarpine, useful in renal dropsy, contra- 
indicated in cardiac types, 193, 403 

Potassium iodide, in hepatic cirrhosis and 
localized effusions, to remove liquid, 403 

Scoparius, infusion, may be used, 403 

Senega, rarely of value, 268 

Squill with digitalis, prescription for, 273, 402 

Strophanthus, 275 

DYSENTERY, 399 

Alum, internally, 47 

Calomel, in purgative dose, contra -indicated if 
weakness exists, 399 

Copaiba, 141 
' Ergot, useful in bloody stools, 151 

Hamamelis, injections, if much blood is pres- 
ent, 399 

Ice water, injections, if due to inflammation, 
used only in strong persons, 399 

Ipecac, best remedy in acute dysentery, 191 

Lead acetate with opium and camphor, pre- 
scription for. 200 

Mercury bichloride, gr. 1-100, or (gr. y 2 in water 
5 ounces) teaspoonful hourly till relieved, 
214, 399 

Xitro-bydrochloric acid, if due to defective ac- 
tion of secretory glands, 227 

Silver nitrate, rectal injections (gr. 10 to 20 to 
the ounce) if ulcers are chronic, followed 
by salt solution if action is too severe, 399 

DYSMENORRHEA, 103 

Amyl nitrite, often relieves, 54 

Antipyrin or acetanilide, in neuralgic attacks, 
in other cases of doubtful value, 62, 404 

Belladonna, suppository, gr. % of extract, or 
ointment applied to os ; tincture, inter- 
nally, useful to relax spasm, 75, 404 

Camphor with acetanilide or antifebrin, in 
pill, useful in nervous cases, 93 



Cannabis indica and gelsemium, often of ser- 
vice, 97, 161, 404 
Epsom salts, or aloes, if constipation is present, 

404 
Hot sitz-bath, followed by turpentine stupe, 

and Dover's powder, gr. 10, often relieves, 

321, 404 
Iron, strychnine, and quinine, as tonics, with 

rest and horseback riding for anaemic and 

run-down patients, 404 
Opium with belladonna, to relieve spasm and 

pain, 235 
Potassium bromide, 84 
Water, cold and hot alternately dashed over 

loins in atonic cases, 404 

DYSPEPSIA. (See Indigestion.) 

Arsenic, useful in atonic types, 69 
Bismuth, when due to acid fermentation, 80 
Hydrastis, as an antiseptic and curative agent 

in chronic types, 171 
Hydrochloric acid, if gastric secretion is defi- 
cient, 171 
Nitric acid with bitter tonics often relieves in- 
testinal types, 225 
Oxygen water, often useful, 240 
Permanganate of potassium, 244 
Quassia useful, if not due to gastritis, 253 
Serpentaria, as a tonic in atonic types, 269 
Terebene, useful as an antiseptic in fermenta- 
tive dyspepsia, 285 

DYSPNOEA, 405 

Ammonium carbonate, as a respiratory and 

cardiac stimulant, 405 
Arsenic . useful in emphysema and chronic 

pulmonary inflammation, continuously 

employed, 405 
Dry cupping over back when due to cardiac or 

pulmonary trouble, 405 
Hyoscine, contra-indicated, 405 
Morphine, gr. % to % night and morning, often 

cures, when due to nervous or cardiac dis- 
orders, 405 
Opium, if due to nervous disorders, 407 
Strychnine, in idiopathic types and when due 

to bronchorrhcea in old people, 230, 405 

EAR, DISEASES OF. 

Glycerin useful to soften impacted cerumen. 

164 
Potassium permanganate, solution useful in 

otitis media, 244 

ECLAMPSIA, 530 

Chloral and bromide, each 1 drachm, by rec- 
tum, before applying hot pack, 532 

Chloroform, pushed rapidly as possible, at onset 
of attack, 532 

Elaterium, gr. %, rubbed up with butter, or 
compound jalap powder, may be substi- 
tuted for c rot on oil, 531 

Ether, as an anaesthetic, contra-indicated, 532 

Extraction of child rapidly as possible, if at- 
tack comes on during labor, 532 

Ice-bag to head, while in warm pack, 531 



39 



610 



INDEX OF DISEASES AND REMEDIES 



Morphine, veratrum viride and amyl nitrite, 
may be held in reserve, to he used if neces- 
sary, 532 

Pilocarpine, contra-indicated, 531 

Venesection, hot wet pack, and croton oil, gtt. 
2, on tongue, to eliminate poison, 531 

ECZEMA, 405 

Arsenic, only when skin is very dry, 407 
Cantharis, internally in small doses, 9S 
Carbolic acid ointment (minims 10, to cerate 1 

ounce) to prevent itching, 104, 407 
Green soap, as a detergent stimulating applica- 
tion, 270 
Hygienic measures and diet, 406 
Ice-water injections, highly recommended in 

eczema of anal margin, 310 
Ichthyol ointment, highly recommended, 175 
Iron, syrup of iodide, in young children with 

anaemia and debility, 178 
Liquor carbonas detergens, in acute cases, 407 
Lead, dilute solution of subacetate, a useful 

lotion, 200 
Ointments, prescriptions for, 239, 254. 406, 407 
Poultices, or olive oil with carbolic acid (gtt. 
1 to 2 to the ounce), followed by soap and 
water, necessary in some cases to soften 
scales, before use of ointment, 406 
Resorcin solution (gr. 2 to 30 to the ounce) lo- 
cally applied in subacute types, in chronic 
form, ointment (gr. 2 to 10 to the ounce), 
407 
Salicylic acid, ointment (gr. 30 to 60 to lard 1 
ounce) in chronic or weeping types, 261, 407 
Sulphides, bath of, often beneficial, 276 
Tar ointment, in chronic forms, 407 
Zinc carbonate, as a protective powder in 

weeping eczema, 106 
Zinc oxide, as a dusting powder, or ointment 
in early stages applied directly or on lint, 
generally preceded by black wash, 406 

EMISSIONS, 408 
Bromide of sodium or potassium, grs. 20 at 

bedtime, valuable in spinal irritability, 

83, 408 
Chloral, grs. 20, at bedtime, 408] 
Cold douches to perineum and scrotum, 309 
Hyoscine, gr. 1-100, of great value, 174, 408 
Hygienic measures, 408 
Potassium citrate, grs. 20, thrice daily, to 

render urine non-irritating, 408 
Strychnine and arsenic, in full dose, of great 

service in genital atony, 408 
Warm bath before retiring, often useful, 408 

EMPHYSEMA. 

Cod-liver oil, useful, 135 

Physostigma, aids in expelling mucus, 250 

Strychnine, 230 

EMPYEMA. 

Iodine, 'gr. 6 ; potassium iodide, gr. 6 ; water, 
1 pint ; as an irrigating fluid, used daily, 
187 



ENDOCARDITIS, 409 

Aconite, tincture of, gtt. 2 to 3 hourly, in early 
stage of acute sthenic types, 409 

Anti-rheumatics, anti-lithics, or iodides, if due 
to diathetic taint, 409 

Calomel, gr. 1-4, with morphine gr. 1-10, every 
two hours, in early stages, 409 

Digitalis, to strengthen heart in later stages, 
409 

Iron, tincture of chloride, with supportive 
treatment, in purulent form, 409 

Leeches, or wet cups, in early stages, to abort, 
409 

Lithium citrate, or acetate, or citrate of potas- 
sium, to prevent calcareous deposit in 
valves, 409 

Mercury, in full dose, in sthenic cases, 210 

Veratrum viride, same as aconite, 409 

ENTERITIS. (See Dysentery and 
Diarrhoea.) 

Magnesium sulphate, 205 

EPIDIDYMITIS, 447 

Heat, moisture, and pressure, in later stages, 
to relieve induration, 448 

Horand-Langlebert's dressing, 447 

Ice-bags, 447 

Iodide of potassium, grs. 10 to 20, thrice daily, 
to remove induration, 448 

Iodine, or silver nitrate solution, painted over 
scrotum, accompanied by cold application 
and rest in bed, 316 

Mercury and belladonna ointments, equal 
parts, or iodine, grs. 4, with lanolin, ounce 
1, locally applied, to relieve induration, 
448 

Rest in bed, elevation of pelvis and testicles, 
cessation of local gonorrhoeal treatment, 
and administering treatment for acute in- 
flammation, 447 

Silver nitrate, solution, painted over scrotum, 
in early stage, may relieve, 223, 447 

Strapping and suspending testicle, to reduce 
inflammation, 447 

EPILEPSY, 409 

Amyl nitrite, inhalations, when aura is per- 
ceived and in status epilepticus, also to 
relax spasm, 54, 417 
Ammonium or sodium nitrite, used to supple- 
ment amyl nitrite, 417 
Antifebrin and antipyrine, especially useful in 

chronic cases when bromides fail, 419 
Belladonna, with bromides, recommended, 

415 
Bleeding harmful, except in mark ed cerebral 

congestion, 420 
Borax, of doubtful value, 419 
Bromate of potassium, 414 
Bromide of ammonium should be used with 
other drugs, 51, 414 
calcium, 86 

iron, when ansemia is present, 414 
lithium, highly recommended in some 
cases, 414 



INDEX OF DISEASES AND REMEDIES. 



611 



Bromide of nickel, 414 

potassium, the most reliable, in ascend- 
ing dose, 83, 414 
sodium, not so apt to disorder stomach, 
414 
Cannabis indica, 415- 
Chloral, alone or with bromides, well diluted, 

after meals, used with care, 41S 
Diet, 420 
Digitalis, with bromides, useful in some cases, 

414 
Gelsemium, with cannabis indica, often of 

value, 415 
Hydrobromic acid, liable to derange digestion, 

414 
Iodide of potassium, very useful in syphilitics, 

416 
Iron, in mal-nutrition, 418 
Mercury, instead of potassium iodide, when 

due to gumma, 418 
Monobromated camphor, 95 
Mtro-glycerin, useful in some cases of petit 

mal, 417 
Opium with gelsemium, only to be used when 

other remedies fail , 416 
Potassium nitrate. 226 
Quassia injections, when due to worms, 419 
Quinine and salicylic acid, contra -indicated, 

420 
Silver nitrate, may be tried when other reme- 
dies fail, 223, 416 
Strychnine, contra-indicated, except in rare 

cases, 420 
Zinc salts, seldom used of late, 416 

EFISTAXIS, 420 

Aconite or veratrum viride tincture, gtt. 2 to 4, 
in sthenic cases, followed in thirty minutes 
by smaller dose, if necessary, 421 

Acetanilide has been recommended, 33 

Acetic acid, locally applied, to arrest, 34 

Alum powder, pure or half and half with 
starch, as a snuff, 421 

Compression of facial artery may be necessary, 
421 

Ergot, turpentine, hamamelis, or oil of eri- 
geron, internally, in slow oozing, 421 

Hot foot-bath, or hot or cold water bags ap- 
plied to dorsal vertebra?, may arrest, 421 

Ice applied to nose may arrest, 421 

Ipecac in nauseating doses, recommended, 421 

Monsel's solution, in spray (gtt. 30 to ounces 4), 
only to be tried when other remedies fail ; 
very disagreeable, 179, 421 

Plugging anterior and posterior nares, if neces- 
sary, with cotton or lint soaked in vinegar, 
421 

Tannic acid, in powder or solution, snuffed up 
nostril, 421 

Vinegar or lemon juice injected into nostril, 
421 

EPITHELIOMA. 

Arsenious acid and gum acacia (of each one 
ounce, to five fluidrachms water), locally 
applied, 69 

Acid nitrate of mercury, applied to part with 
glass rod, 217 



ERYSIPELAS, 422 

Antipyrine, to control fever, 422 

Belladonna tincture, internally, minims 4 to 5, 
every four hours, and locally applied on 
lint or ointment smeared over part, 422 

Bitters and iron, during convalescence, as 
tonics, 422 

Boracic acid, as a lotion, 80 

Ichthyol ointment and \aseline, half and half, 
locally applied, preceded by Avashing with 
castile soap, followed by bichloride (1 to 
1000), 423 

Iodine, tincture painted around inflamed 
edges, to arrest, 187 

Iron, tincture of chloride, gtt. 20 to 40, thrice 
daily, best internal treatment, 422 

Pilocarpine, gr. 1-8 to 1-6, hypodermically . 
contra-indicated in debility, also injected 
around borders of inflammation in some 
cases, to arrest, 422 

Silver nitrate, solution (gr. 80 to the % ounce), 
applied tAvice or thrice, to arrest, 423 

Veratrum viride or aconite, in early stages of 
sthenic cases, 422 

White lead paint, locally applied, Avhen ich- 
thyol is not at hand, 423 

EXHAUSTION AND 

DEPRESSION, 423 

Stimulants, 423 

EXOPHTHALMIC GOITRE. 

Belladonna relieves some cases, 76 
Sparteine, 267 

EYELID, ECCHYMOSIS OF. 

Alum, curd or solution, to prevent discolora- 



tion, 41 



Alcohol, 39 



FAINTING. 



FEET, SWOLLEN, TENDER, AND 
SWEATING, 423 

Arsenic, gr. 1-60 to 1-40, in swelling of old per- 
sons, 429 

Borax, stockings soaked in saturated solution 
and dried each day, Avhen sweating is ex- 
cessive, 424 

Carbonate of calcium, precipitated, locally ap- 
plied to sweating feet, 90 

Cotton, instead of Avoollen, stockings may aid 
cure, 424 

Hamamelis, distilled, or fluid extract, drachm 
% to 1 of former, or gtt, 10 to 20 of latter, 
424 

Lead plaster and linseed oil, equal parts, on 
linen to feet, every third day, in sweating, 
201 

Prescription for dusting powder, 424 

Rest, absolute, of feet, may be necessary in 
swollen feet, 424 

Salicylic acid and borax, equal parts, in Avater 
and glycerine, best application to sweating 
and tender feet, 424 



612 



INDEX OF DISEASES AND REMEDIES. 



FELON. 

Bread-crumbs saturated with liquor plumbi 
subacetatis, as a poultice, to abort, 200 

Silver nitrate, solution, applied early, to abort, 
223 

FEVER, 424 

Aconite, the best depressant for sthenic types 
in children, 37 

Alcohol, as a systemic support and stimulant 
in low fevers, 39 

Antifebrin, 32 

Antipyretics, useful in most sthenic fevers, 
often fail in thermic fever, 423 

Antipyrine, 61 

Digitalis, in small dose, valuable in exhausting- 
fevers, 148 

Cold applications and baths, 313 

Cold packs and baths, in asthenic types, to be 
relied on first ; if impracticable, then anti- 
pyretics, 430 

Musk, by rectal injections, valuable in low 
stages, 218 

Neutral mixture, useful as a febrifuge, espe- 
cially in children, 130 

Phenacetine, 245 

Salicylic acid and resorcin, inferior to other 
drugs as antipyretics, 254, 259 

FIBROIDS. 

Ergot, used as an expulsive and curative rem- 
edy, 151 

FLATULENCE. 

Asafcetida, 71 

Aromatic powder, 130 

Camphor, 93 

Capsicum, prevents formation of gas, 100 

Chloroform, gtt. 1 to 9, or spirit, gtt. 10 to 20, 

will relieve, 123 
Cloves, a useful tonic and stimulant, 131 
Hoffmann's anodyne, the best carminative, 168 
Pepper, 242 
Peppermint, 242 
Potassium permanganate, 244 
Turpentine, prescriptions for, 289 

FRECKLES AND CHLOASMA, 431 

Almonds, emulsion supposed to be of value, 43 
Boracic acid, saturated solution, applied same 

as corrosive sublimate, wash, 431 
Corrosive sublimate (gr. 1 to 4 to the ounce), 

applied night anl morning until irritation 

appears, then stop for some days and again 

renew, 430 
Lactic acid (gr. 10 to the drachm) applied same 

as corrosive sublimate, 431 
Prescriptions for, 431 
Prescription for chloasma of pregnancy, 239 

FURUNCLES. (See Boils.) 

GALACTORRHCE A, 529 

Antipyrin, gr. 2%, thrice daily, said to decrease 

secretion, 529 
Caustic, introduced into uterus, successful if 

due to stoppage of menstruation, 529 



Chloral should be tried, 529 

Compression of gland with applications of 
belladonna ointment and potassium iodide 
internally, usually relieves, 529 

Diet, 530 

Electricity, generally ineffective, 529 

Ergot, long continued, highly recommended, 
529 

Malt, wineglassful at midday and evening 
meals, useful addition to diet ; pyrophos- 
phate of iron, gr. 5, in addition, if anaemia 
is present, 536 

Warm douches, 529 

GANGRENE. 

Bromine, as an escharotic, 87 

Carbolic acid, spray (gtt. 5 to 10 to the ounce), 

useful in pulmonary gangrene, 103 
Nitric acid, to destroy tissue, 225 

GASTRALGIA,431 

Alum, 47 

Arsenic with iron, the most reliable remedy, 

prescription for, 432 
Bismuth and pepsin, 1 to 1% hours after meals, 

to prevent pain, 432 
Bromides or valerian, alternated with other 

treatment, if case is neurotic, 432 
Cod-liver oil in emulsion with hypophosphites, 

occasionally better than arsenic and iron, 

432 
Counter-irritation, and a vigorous revulsive, 

especially useful in hysteria, 431 
Cyanide of potassium, dilute hydrocyanic acid 

or chloroform as a substitute for bismuth, 

if it favors constipation, 432 
Diet and hygiene, 431 
Emesis and purgation, when due to indigestible 

food, 431 
Hot applications, stimulating infusions, hot 

brandy or whiskey or laudanum, gtt. 30 to 

60, during acute stage, 431 
Massage, enemata, diet, or suppositories of glu- 
ten, glycerin, or soap, to overcome consti- 
pation, 432 
Hydrocyanic acid, useful in nervous types, 172 
Nitro-glycerin, 226 
Potassium nitrite, gr. 3 to 5, 226 
Salicylic acid, useful in paroxysmal forms, 260 

GASTRIC CATARRH, ACUTE, 432 

Ammonium muriate, useful in subacute forms 
in children, 52 

Diet, principal point in treatment, 432 

Effervescing draughts, useful in convalescence, 
433 

Emetic, mild, to dislodge fermenting mass, if 
present, 433 

Ice, to quench thirst, if anorexia is great, 433 

Iron, if anaemia exists, 433 

Milk with large percentage of lime- water, 433 

Salicylic acid, valuable in vomiting, 260 

Salt, in moderation with food, 433 

Seidlitz powder, one-fourth of one every fifteen 
minutes, to settle stomach and remove fer- 
menting mass, 433 



INDEX OF DISEASES AND REMEDIES. 



613 



Sodium bicarbonate with gentian, useful in 
convalescence and in children. 162, 433 

Spice poultice, to relieve epigastric distress, 
157 

Tartar emetic, given early, in acute attack of 
children, may abort, 58 

GASTRIC CATARRH, CHRONIC, 

433 

Apomorphine, as an emetic, to throw off mucus. 
65 

Bismuth subnitrate, added to prescription, if 
hyperacidity exists, 434 

Cascara sagrada, if constipation exists, 434 

Diet, such as koumys, light broths, and mat- 
zoon, 434 

Silver nitrate and hyoscyamus, along with 
counter-irritation and regulated diet, pre- 
scription for, 434 

GASTRIC DILATATION, 434 

Cod-liver oil, by stomach or inunction, if due 

to rhachitis, 434 
Diet, 434, 430 
Euemas, nutrient, often useful, especially in 

older children, 436 
Gentian and calumba, useful as tonics, 437 
Iodide of iron, syrup of, lacto-phosphates of 

lime, or phosphate of sodium, in strumous 

diathesis, 434 
Lavage, 435 
Physostigma, tincture, gtr. 5 to 10, or extract, 

gr. ~% to 34, to improve muscular coats, 437 

GASTRIC ULCER, 437 

Bismuth, as an astringent and sedative, 80 

Bromide of sodium, by rectum, to control vom- 
iting, prescription for, 438 

Counter-irritation, mild continuous, over 
belly, to relieve pain, 437 

Diet and hygiene, 43S 

Ergot or cracked ice, internally, to control 
haemorrhage, 438 

Silver nitrate with hyoscyamus, opium or bel- 
ladonna in pill, half to one hour before 
meals, 222, 437 

Stimulants, cardiac, guardedly administered, 
external heat and rubbing, in collapse fol- 
lowing haemorrhage or perforation. 437 

Spice plaster, useful as a mild continuous 
counter-irritant, 437 

GASTRITIS, ACUTE, 438 

Belladonna internally and flaxseed poultice 
over epigastrium and chest, if collapse 
threatens, 438 
Bismuth, as an astringent and sedative, 80 
Flaxseed tea, a useful demulcent, 159 
Mucilaginous drinks and albuminous sub- 
stances freely given, 438 
Oils, to prevent spread of inflammation, 438 
Opium, in fluid form, to relieve pain and irri- 
tation, 438 
Warm water, internally, or stomach-pump, to 
unload stomach, at onset. 43S 



GASTRO-ENTERITIS, 439 

Castor oil or magnesium sulphate, to sweep out 
poison, 439 

Morphine hypodermically. to allay pain, fol- 
lowed or preceded by mild emetic, if irri- 
tating substance remains, 439 

Opium and sulphuric acid, with hot applica- 
tions or plasters to belly to control irrita- 
tion and diarrhoea, 439 

GASTROINTESTINAL 
CATARRH. 

Diet for seven-year-old child, 330 

Garlic, as a poultice to belly equal to spice 
poultice, 43 

Hydrastis, especially useful if due to alcohol- 
ism, 170 

Sanguinaria, of service if jaundice is present, 
263 

Tar, in 2-gr. pills, 251 

GIDDINESS. 

Cod-liver oil with quinine, valuable in old age, 
136 

GLANDS, DISEASE OF. 

Ammonium iodide and glycerin (gr. 30 to the 

ounce) locally applied to enlarged tonsils, 

52 
Ammoniac plaster, as a stimulant to enlarged 

glands, 53 
Carbolic acid, solution 2 per cent., injected 

into glands threatening suppuration, 104 
Carbon disulphide, in enlarged glands, 106 
Cod-liver oil, in lymphatic enlargements, 145 
Ichthyol ointment, valuable as an inunction 

in lymphatic enlargements, 175 
Iodine, the best remedy for enlargements, 186 
Mercury ointment as an inunction in enlarged 

glands, 211 

GLAUCOMA, 439 

Atropine, contra-indicated, 440 

Eserine, useful if operation is delayed, 440 

Hot compresses, leeches, and opiates to relieve 

pain, 440 
Iridectomy, the only curative measure, 440 

GLEET. 

Antimonial ointment, constantly applied, until 
slough forms, necessary in some cases, 316 

| Bichloride of mercury, injection (gr. ]4 to 
water ounces 6), every three or four hours, 
215 

'■ Cantharidal collodion, applied to under sur- 
face of penis, or perineum ; if this fails, 
caustic potash or soda, arsenic, or red-hot 
iron may be used, 316 

! Cantharides, 98 

j Gurjun oil, 166 

j Turpentine, internally, 289 

I Uva ursi, 290 

GOITRE. iSee Bronchocele.) 



614 



INDEX OF DISEASES AND REMEDIES. 



GONORRHOEA, ACUTE, 440 

Aconite, gtt, 2, every two or three hours, if 
inflammation is high, 442 

Almond emulsion, diminishes burning on 
urination, 44 

Benzoic acid, with cannabis indica, useful in 
later stages, 77 

Bicarbonate of sodium or potassium citrate, gr. 
10, after meals, increasing, if necessary ; re- 
lieves ardor urinse, 442 

Cannabis indica, ofcen used instead of copaiba 
and cubebs, 97 

Cocaine, solution (4 per cent.) instilled into 
urethra before urination, diminishes ardor 
u rinse, 442 

Copaiba, to relieve ardor urinje and stimulate 
mucous membrane in later stage, 141, 442 

Cubebs, useful in later stage, 145, 442 

Diet and hygiene, 442 

Gurjun oil, of value in place of copaiba and 
cubebs, 166 

Erigeron oil, occasionally used instead of 
copaiba and cubebs, 152 

Eucalyptus, valuable in subacute stages, 157 

Hydrastis, one of the best remedies, locally 
and internally in later stages; also as a 
vaginal wash for females, 170, 171 

Hot sitz-bath, prolonged, and hot-water injec- 
tions ; useful in females, 448 

Lead acetate, injection, gr. 1 to 8 to the 
ounce, 200 

Lead-water or laudanum, or alcohol and 
water, applied on a cloth to penis, during 
inflammation, 441 

Mercury, bichloride (1 to 20,000 or 1 to 40,000), 
in large quantities to flush urethra ; in 
females, 2 pints of solution (1 to 4000), thrice 
daily, to irrigate vagina, 440, 448 

Opium or belladonna, hypodermically or in 
suppository, to control pain in posterior 
urethritis, discontinuing active treatment, 
and observing strict hygiene and diet, 443 

Prescription, for infusion, 171 

Prescriptions for injection for posterior ure- 
thritis, 444 

Quercus alba, injections, useful in females, 
253 

Salol, cubebs and copaiba, prescription for, 
442 

Silver nitrate, injections (gr. 2 to 4 to the 
ounce), useful in subacute stage ; in 
females, gr. 4 to 60 to the ounce, painted 
over vagina, followed by astringent cotton 
tampon, 224, 448 

Urinating with penis in hot water, to relieve 
ardor urinse, 442 

Warm baths, lasting one-half to one hour, use- 
ful in early stage, 443 

White's prescription for, 441 

Zinc acetate, injection, gr. 1 to 20 to ounce of 
rose water, 34 

Zinc chloride, injection (gr. 1 to 2 to the 
ounce), occasionally used in second stage, 
117 

Zinc sulphate, weak solution, as an astringent 
injection, 276 



GONORRHOEA. CHRONIC, 444 

Copper sulphate or silver nitrate, solution as 

an application to focus of inflammation, 

after dilatation, 444 
Prescription for, 444, 445 
Pressure and use of cold, often valuable, 445 
Dilatation, if stricture exists, 445 
Sandalwood oil, to stimulate depraved mucous 

membrane, 262 
Silver nitrate, solution, if discharge persists 

after dilatation ; also in posterior urethritis, 

444, 445 
Uva ursi, 290 

GOUT, 449 

Antipyrine, said to have a specific effect, 62 

Baths of sulphides, 276 

Blisters, flying, short distance from inflamed 
joint, every few days, 450 

Chloral, in insomnia, 450 

Chloroform liniment, applied over affected 
part, 123 

Cod-liver oil, 135 

Colchicum, wine of the root, gtt. 20, increas- 
ing by gtt. 1 every four hours, till relief or 
poisoning symptoms appear in acute types, 
449 

Collodion, not more than 1 or 2 coats; also 
useful with iodine, 138, 450 

Diet, 450 

Fowler's solution, gtt. 3 in water, a standard 
remedy in subacute and chronic types, 
451 

Iodide of iron, syrup of, and cod-liver oil if 
anaemia is present, 451 

Iodide of potassium, to relieve night pains ; 
also with colchicum, in chronic gout, 450 

Iodine, ointment or tincture, locally applied 
to chronic gouty joints, 451 

Leeches or venesection, contra-indicated, 450 

Lithium carbonate or citrate (gr. 5 to 10 to the 
ounce), locally applied, to dissolve deposit 
at joints, 450 

Morphine, hypodermically, near painful spot 
to relieve acute pain, 449 

Peppermint oil, locally applied, 450 

Potassium bromide, the best remedy for in- 
somnia, 450 

Sodium bicarbonate and Unseed oil (1 to 9), 
locally applied to joints, 450 

Stimulants, ether hypodermically, opium ex- 
cept in brain or kidney disturbances ; diu- 
retic and alkaline drinks and counter-irri- 
tation, in retrocedent gout, 451 

Water, distilled or medicinal, in large amounts, 
449 

GRANULAR LIDS, 451 

Atropine, instillations, in acute forms, 451 
! Boracic acid or salicylic acid, solution, as a 

wash in acute forms, 451 
j Boro-glyceride (20 to 50 per cent.), applied to 

chronic granulations, 451 
l Carbolic acid, applied pure, to chronic granu- 
lations ; excess removed with water, 451 

Copper sulphate, crystal, applied to chronic 
granulations, 451 



INDEX OF DISEASES AND REMEDIES 



615 



Corrosive sublimate, solution (1 to 200 or 1 to 
500), applied every second day in chronic 
forms, preceded by cocaine : eyes also 
being irrigated thrice daily with solution 
(1 to 7000), 451 

Crushing granulations, often satisfactory, 452 

Glyceroleof tannin, applied to chronic granu- 
lations, 451 

Excision of granulations when isolated, 452 

Jequirity, rarely used, 452 

Leeches, to temple, to reduce inflammation in 
acute stage, 451 

Scarification, not advisable, 451 

Silver nitrate stick or solution (gr. 10 to the 
ounce), applied daily, if there is discharge ; 
neutralize excess, 224, 451 

Yellow oxide of mercury ointment with lard, 
equal parts, in chronic types, 216 

GRAVES'S DISEASE. (See 
Exophthalmic Goitre.) 

GRIPING. 

Allspice or ginger, to prevent griping of pur- 
gatives, 44, 163 

GROWTHS, PATHOLOGICAL. 

Caustic potash or soda, occasionally used, to 

destroy, 110, 111 
Chromic acid, as a caustic, to growths on skin 

or mucous membranes, 124 
Lime, as an escharotic on hairy growths, 92 

GUMS, DISEASES OF. 

Burnt alum, useful applied to swollen gums, 
47 

Catechu, as a mouth-wash, for spongy gums, 
110 

Cocaine, locally applied, in soreness and ten- 
derness of gums, 133 

Iodine, solution (gr. 1 to the ounce), locally 
applied, followed by rinsing mouth, when 
gurus are retracted, 220 

Myrrh, tincture, locally applied, to spongy or 
tender gums, 220 

HaEMATEMESIS, 459 

Ergot, hamamelis or ipecac, in slow bleeding, 
459 

Ice, cracked, swallowed frequently, 459 

Iron, tincture of chloride, or turpentine, in- 
ternally, if passive, 459 

Lead acetate with morphine or opium, gr. 2 
to 3, in pill, 459 

Monsel's salt, gr. 2 to 3 in pill, 459 

Monsel's solution, gtt. 3 in a half tumblerful of 
water, every fifteen minutes, 459 

Silver nitrate, gr. 1-4 in pill, in slow bleeding, 
459 

Tannic acid, gr. 20 to drachm of Avater, must 
not be given with Monsel's solution, 459 

HEMATURIA, 461 
Alum, injections into bladder, if alarming, 461 
Camphor, gr. 10 to 20, in divided doses, in pill, 

461 
Cannabis indica, useful in some cases, 461 



Ergot, 461 

Erigeron, 461 

Gallic acid, gr. 20, very valuable, 461 

Hamamelis, injected daily into bladder, 167 

Prescriptions for, 461 

Quinine, if due to malaria, 461 

Rhus aromatica, 255 

Styptic injections, should only be used when 

bleeding is alarming, 461 
Turpentine, 461 

HEMOPTYSIS, 458 

Acetanilide, has been recommended, 33 

Aconite, to prevent pneumonia following, con- 
tra-indicated in exhaustion, 459 

Alum, solution (gr. 20 to the ounce), in fine 
spray, 47 

Ergot, fluid extract, 1 to 1% drachms, inter- 
nally, 459 

Gallic acid, gr. 20 to ounce of water, when 
ergot is not at hand, 459 

Hamamelis, 167 

Ice or dry cup, over bleeding spot, 459 

Ipecac, in small doses, very effective, 191 

Morphia, hypodermically, to allay nervous- 
ness, 459 

Tannic acid, Monsel's solution or alum, used 
in spray, as styptics, prescriptions for, 458, 
459 

HAEMORRHAGE, 457 

Alum, a useful styptic, applied to bleeding 
vessel, 47 

Arnica, 65 

Compress, soaked in antiseptic liquid or filled 
with antiseptic powder, preferable to 
styptics, 457 

Ligation preferable to styptics, w r hen applic- 
able, 457 

Oil of erigeron, 152 

Packing or astringents, if bleeding point can- 
not be reached by compression or for liga- 
tion, 457 

Tannic acid, 283 

HAEMORRHAGE, INTESTINAL, 

459 

Enemas, styptic, for haemorrhage from rectum 
or colon ; alum (gr. 10 to the ounce), copper 
(gr. 5 to the ounce), Monsel's solution (dr. 1 
to 2 ounces), Monsel's salt (gr. 10 to the 
ounce), chlorate of potash (gr. 10 to 25 to the 
ounce), and tannic acid (gr. 20 to ounce of 
glycerin and water), 460 

Ergot, 460 

Ice, by mouth, and Monsel's salt, gr. 3, in hard 
pill, every half hour or oftener, 459 

Ice-water, injections in blood-purging of dys- 
entery, 461 

Lead acetate and camphor, in pill, of service 
in some cases, 460 

Monsel's solution not advisable, 179 

Sulphuric acid, gtt. 5 to 10 in water, 460 

Tannic acid, in solution or pill, when Monsel's 
salt is not at hand, 460 

Turpentine, in capsule or emulsion, when 
bleeding is not active, 289, 460 



616 



INDEX OF DISEASES AND REMEDIES. 



HEMORRHOIDS, 462 

Aloes, 45 

Cold water injections in the morning, relieve 
congestion and cause easy evacuation, 462 
Ergot, sometimes useful in bleeding piles, 151 
Gallic acid and opium, ointment, prescription 

for, 462 
Hamamelis, as a lotion or injection, 167, 462 
Nitric acid, lightly touched to one or two 

points, 225 
Potassium chlorate, with laudanum, as an in- 
jection, 117 
Quercus alba, as an astringent wash, 253 
Rhubarb root, gr. 10 to 20, chewed before re- 
tiring, to relieve constipation, 462 
Stillingia, prescription for, 274 
Sulphur, to produce soft passages, 279 
Tannic acid, suppositories in bleeding piles, 

284 
Tobacco, contra-indicated, 288 

HAY FEVER. 

Arsenic, 68 

Cocaine, with bismuth and morphine, as a 

snuff, 133 
Resorcin, solution 20 per cent., in spray, 254 

HEADACHE, 452 

Belladonna, valuable in young people, 76 

Caffeine, with antipyrine or bromide in nervous 
headache, 89 

Capsicum plaster, to nape of neck, 100 

Cimicifuga, if due to eye-strain, 125 

Croton chloral, if due to eye-strain or associated 
with sick stomach, 115 

Cup, to nape of neck, in congestion, 452 

Ergot, if due to congestion, 452 

Eucalyptus, 157 

Gelsemium, if due to nervous troubles or eye- 
strain, 161 

Heavy magnesium, in headache due to gastric 
acidity, 205 

Hydrobromic acid, if due to eye-strain in ner- 
vous women, 87 

Liquor magnesia citratis, in sick headache, 206 

Mustard foot-bath and plaster to n ape of neck, 
in congestion, 452 

Nux vomica, gtt. 1, every five or ten minutes 
till 10 drops are taken, in sick headache, 
230 

Oxygen water, 240 

Phenacetine, if due to eye-strain, 246 

Prescription for, 452 

Potassium bromide, 83, 84 

Sjdium bicarbonate, as an antacid in sick 
headache, 78 

Scrych.iiae or- mix vjnica, if due t:> eye-strain 
452 

HEART DISEASE, 453 

Aconite or veratrum viride, often useful in 
palpitation and hypertrophy, 37, 294, 456 

Alonidine, often of service when digitalis 
fails, 456 

Ammonia and ether, followed by digitalis and 
alcohol, in heart failure, 456 



j Amyl nitrite, in single whiffs, often relieves 
cardiac failure, 54 

Barium chloride, in heart failure, 72 

Belladonna, when arhythmia is present, 456 

Camphor, in palpitation, 93 

Cimicifuga, as a tonic in fatty and irritable 
heart when digitalis fails, 125 

Digestive remedies in palpitation due to indi- 
gestion, 456 

Digitalis, to be tried in all heart troubles, ex- 
cept in simple or compensatory hyper- 
trophy, 148, 454 

Diet and exercise, in fatty degeneration, when 
fat is deposited between muscular fibres, 
456 

Hoffmann's anodyne, very useful in palpitation 
due to indigestion or tobacco, 168 

Iron, in palpitation due to anaemia, 456 

Nux vomica, in palpitation, as a stimulant, 456 

Opium, if dyspnoea prevents sleep, 236 

Sparteine, in arhythmia or palpitation, also as 
a substitute for digitalis, if it fails, 267, 456 

Strophanthus, may be tried if digitalis fails, 
275, 456 

Veratrine ointment, recommended, applied to 
chest in some cases of palpitation, 456 

HEPATIC ABSCESS, 463 

| Active treatment for dysentery, if present, 463 
Ammonium muriate, thought to be of value, 

52 
Aspiration, when pus forms, 463 
Diet, 463 

; Quinine, after abscess develops, 463 

HEPATIC CIRRHOSIS. 

Ammonium chloride, 52 
; Iodoform, highly recommended, 232 
; Potassium iodide, often useful in early stages, 

184 

HEPATITIS, ACUTE, 462 

Aconite, in early stages, 463 

Ammonium muriate, has been recommended, 

52 
: Cantharidal blister, small, over right hypo- 

chondrium ; if impossible, use mustard 

plaster, 463 
Hot cloths, over counter-irritant, may relieve 

pain and aid in formation of blister, 463 
Saline purgatives, preceded by calomel, gr. 1, 

in divided doses, if constipation exists, 463 
Sweet spirit of nitre with potassium citrate, or 

diuretic waters, to regulate kidneys, 463 
Veratrum viride, rarely used, 463 

HEPATITIS, CHRONIC AND 
SUBACUTE, 463 

Antisyphilitic treatment, if due to syphilis, 464 
Nitro-muriaticacid, most useful remedy, inter- 
nally and externally, 227, 464 
Potassium iodide, useful in all cases, 464 

HERNIA. 

Chloroform, inhalations, to relax muscles dur- 
ing reduction, 122 



INDEX OF DISEASES AND REMEDIES 



♦317 



HICCOUGH, 464 

Belladonna, 75 

Camphor, 464 

Capsicum, tincture, gtt. 2 to 3. 4G4 

Chloral, 114 

Chloroform, 464 

Ether, inhaled or spray thrown on epigastrium, 

455 
Hoffmann's anodyne, especially valuable, 464 
Musk, valuable in all cases, especially in 

typhoid fever, gr. 10. given by rectum, 464 
Nux vomica, accompanied by mineral acids, if 

due to indigestion, 465 
Oil of amber, gtt. 5 to 10 in capsule, one of the 

best remedies, 48, 464 
Pilocarpine hydrochlorate, hypodermieally, if 

due to uraemia, 465 
Valerian, 464 

HOARSENESS. 

Sulphides or sulphur water, if due to cold or 
speaking, 277 

HYDROCELE. 

Iodine, injections after evacuation of the sac, 
the best curative remedy, 187 

HYDROCEPHALUS. 

Potassium iodide, to cause absorption of fluids, 

183 

HYSTERIA. 
Calcium bromide, 86 
Hops, as a nervous sedative, 169 
Monobromated camphor, to produce sleep, 95 
Oil of amber, 48 
"Pill of three valerianates.' - recommended, 

371 
Potassium bromide, 297 
Valerianate of ammonium, 53 

IMPOTENCE. 

Cantharis with nux vomica and iron, may re- 
store sexual power, if loss is due to ex- 
cess, 98 

Cannabis indica, with strychnine, nux vomi- 
ca, or ergot, if no organic trouble exists, 96 

Cold douche to perineum and testicles, in 
atonic types, 312 

INCONTINENCE OF URINE, 465 

Antiseptic fluids, to cleanse bladder, in paral- 
ysis, 466 
Arsenic with nux vomica, in weakness of spinal 

centres, prescription for, 466 
Belladonna, if due to vesical spasm, 75 
Buchu with sweet spirit of nitre, valuable in 

some cases, 87 
Cantharides, gtt. 1, thrice daily, with alkaline 

diuretics, in adults. 466 
Catheterization, in reteution or paralysis, 466 
Circumcision, if prepuce is redundant, relieves 

some cases, 465 
Diuretic waters, used for years, necessary in 

some cases, 466 
Fowler's solution, gtt. \, to 1, in chronic types, 

due to atony. 466 



Hyoscyamus, if due to irritable bladder. 174 

Rhus aromatica, in incontinence of children, 
25ii 

Santonin, often valuable when- other remedies 
fail, 264 

Sweet spirit of nitre and potassium citrate, if 
urine is dark and concentrated, prescrip- 
tion for, 465 

INDIGESTION, GASTRIC AND 
INTESTINAL, 467 

Alcohol, in adynamic types, 467 

Ammonia, if due to large amounts of lactic 
and butyric acids, 470 

Asafcetida, useful in indigestion of old age, 71 

Bitter tonics, useful in atony, contra -indicated 
in gastric irritation, formula? for, 468 

Chiretta, 112 

Diet. 467 

Hydrochloric acid in gastric forms, or combined 
with cardamoms, in intestinal indigestion, 
171 

Nitric acid, in sour regurgitations after meals, 
225 

Ndtro-hydrochloric acid, valuable in many 
cases, 227 

Pancreatine with sodium bicarbonate and alka- 
line mineral waters, in intestinal types, 470 

Pepsin and hydrochloric acid, if due to defi- 
cient secretion, 468 

Podophyllin or mercury, in iieutery, 471 

Prescriptions for flatulence of intestinal indi- 
gestion, 470, 471 

Prescription for torpid liver of indigestion, 471 

Salt, in increased amounts, if gastric digestion 
is imperfect, 469 

Serpentaria, as a tonic, 269 

Strychnine, quinine, and nux vomica, useful 
tonics, prescriptions for, 468 

Yellow oxide of mercury, if there is foul belch- 
ing or ill-smelling stools, 216 

INFLAMMATION. 
Cannabis indica, valuable in chronic types. 97 
Hop poultice, 167 
Liquor plumbi subacetatis, useful as a topical 

application, 200 
Opium, 235 

Cocaine, in acute types, prescription for, 133 
Veratrum viride, 294 

INSANITY. (See Mania, Acute.) 
INSOMNIA, 471 
Amylene hydrate, useless if due to pain, 473 
Bromide of potassium with Fowler's solution, 

in nervous females, prescription for, 472 
Bath, cold, in cerebral ansemia, hot in nervous 

irritability, 309 
Chloral, useful if not due to pain, prescription 

for, 471 
Chloralamide, gr. 15 to 60, in wine or capsule, 

in nervous insomnia, 115, 473 
Croton chloral, preferable to chloral, if due to 

pain, 115 
Hop pillow. 169 
Hot-water bags to feet and cold to head, if due 

to cerebral hypersemia, 472 



618 



INDEX OF DISEASES AND REMEDIES, 



Hyoscine, gr. 1-100 to 1-90, by mouth or gr. 1-110 
to 1-100, bypodermically, in mania or hys- 
teria, 174, 472 

Morphine with chioral, if clue to pain, prescrip- 
tion for, 472 

Opium, only to be used in pain, 235 

Paraldehyde, prescription for, 472 

Potassium bromide, in nervousness and over- 
work, 84 

Somnal, minims 4 to 10, in liquorice and water, 
473 

Sul phonal, prescription for, 472 

Valerian, in nervousness, 291 

INTERMITTENT FEVER, 473 

Alcohol, contra-indicated during chill, 474 

Anesthetization, has been employed to put off 
paroxysm, 474 

Antipyrine, if fever is excessive, 474 

Arsenic, in intervals between attacks, as an 
antiperiodic, 474 

Calomel, gr. % to 34, every 15 minutes until 1 
grain is taken, 4 or 5 hours before quinine, 
if constipation exists, 473 

Chloroform inhalations, preceded by lauda- 
num, by mouth or rectum, or morphine, gr. 
1-6, with atropine, gr. 1-60, hypodermically 
if death threatens during chill, 474 

Cool drinks and sponging, in fevered stage, 474 

Digitalis, to relieve internal congestion' during 
chill, 474 

Ice-pack, if fever is long continued and exces- 
sive, 474 

Podophyllin, gr. 1-10 to 1-8, preceding quinine, 
if constipation is present, 473 

Potassium or sodium nitrite, gr. 10, have been 
employed to put off attack, 474 

Quinine, as a prophylactic and antiperiodic, 
473 

INTERTRIGO. (See Chapping.) 

INTESTINAL CATARRH. 

Ammonium chloride, useful in subacute types, 

52 
Chlorate of potassium, injections (gr. 20 to the 

ounce), in acute rectal catarrh, 117 
Iodide of potassium, if ammonium chloride 

fails to relieve, 183 
Salol, 262 

IRITIS, 474 

Atropine, the best local remedy, 475 

Counter-irritation, 315 

Daturine or duboisine, when atropine cannot 
be used, 475 

Ice compress, in early stage of traumatic iritis, 
475 

Eserine, 250 

Iodide of potassimn, alone or with mercury bi- 
chloride, following mercurial impression, 
in syphilitics, 475 

Leeches and dry heat or hot fomentations, to 
relieve pain, 475 

Mercury, preferably by inunction, if due to 
syphilis, 475 

Morphine, if pain is severe, 476 

Paracentesis, 475 



Pilocarpine, internally if vitreous becomes 
opaque, also in gonorrhceal types, 475 

Salicylic acid or oil of gaultheria, followed 
later by potassium iodide, in rheumatic 
iritis, 475 

Saline laxatives, during course of disease, fol- 
lowed by iron, after cessation of specific 
treatment, 476 

Turpentine accompanied by potassium iodide, 
in plastic iritis, following secondary syph- 
ilis, 474 

IRRITABILITY. 

Almonds, as a drink in irritability of intestines 
and air-passages, 43 

Cantharis, recommended in irritable bladder 
of women and children, 98 

Cimicifuga, in uterine irritability, 125 

Hops, in vesical irritability, 169 

Petrolatum, as a soothing agent in gastrointes- 
tinal types, 244 

Potassium bromide, in irritability of the phar- 
ynx, 33 

ITCH. (See Scabies.) 

INVOLUTION, ANOMALIES OF, 

525 

Cannabis indica, of great value in subinvolu- 
tion, 97 

Curette, in subinvolution due to retention of 
hypertrophic endometrium, 526 

Digitalis, in subinvolution due to sluggish cir- 
culation, 536 

Ergot, quinine, and strychnine, in pill, if due 
to fibroids, 526 

Purgatives, disinfectants, and possibly, hot 
water locally applied, if due to inflamma- 
tion, 526 

Removal of placenta, if adherent, 526 

JAUNDICE. 

Calomel, gr. % every half hour till gr. % is 

taken, if due to cold, 212 
Carbolic acid, gr. 10, with water and glycerin, 

each 2 drachms, locally applied in itching 

of jaundice, 104 
Citric acid, 131 

Hydrastis, useful in subacute types, 170 
Iodoform, highly recommended, 190 
Manganese sulphate, may be tried in malarial 

types, 206 
Salol, said to be of value, 262 

JOINTS, ENLARGED. 

Ammoniac plaster, a useful stimulant, 53 

KELOIDS. 
Ichthyol ointment, 175 
KERATITIS, INTERSTITIAL, 476 

Antiseptic lotions, in marked ciliary conges- 
tion, 476 

Antisyphilitic treatment, if due to syphilis, 476 

Atropine, in ciliary congestion, to prevent 
iritis, 476 

Creolin, 143 

Leeches, to temple to relieve pain, if patient is 
not too young for bleeding, 476 



INDEX OF DISEASES AND REMEDIES. 



619 



KERATITIS, PHLYCTENULAR, 

476 

Atropine, to relieve pain, 477 

Boracic acid, solution, to relieve congestion, 

477 
Cocaine, not advisable in photophobia, 477 
Cold-water douche, on closed eyelid to relieve 

photophobia, 417 
Dark glasses, to protect eyes, 477 
Tonics and alteratives, with strict hygienic 

and regulated diet, associated with local 

treatment, 477 
Yellow oxide of mercury ointment, or calomel 

as a dusting powder to hasten cicatrization, 

contra-indicated if iodine is being given, 

477 

KERATITIS, SUPPURATING, 477 
Antiseptic lotions, to limit sloughing, 477 
Cautery, actual, best means of preventing per- 
foration, 478 
Curetting floor of ulcer, if perforation threat- 
ens, 478 
Eserine or atropine, instilled into eye to limit 

sloughing, 478 
Hot compresses, 477 
Massage of cornea, to remove scars of ulcers, 

478 
Pressure bandage, if perforation threatens, 478 
Silver nitrate (gr. 10 to 20 to the once) touched 
to margins of ulcer, if perforation threat- 
ens, 478 

LACHRYMAL ABSCESS, 478 

Division of canaliculi and washing out sac 
with antiseptic fluids, and insertion of i 
probes into ducts after inflammation sub- 
sides, to restore patulency, 478 

Hot compresses composed of lead- water and 
laudanum, to relieve pain. 479 

Puncture of abscess, if rupture threatens, 478 

LARYNGISMUS STRIDULUS. 

Amyl nitrite, 54 
Belladonna, 75 
Gelsemium, 161 

LARYNGITIS, ACUTE, 479 
Abstinence from talking, with bland and un- 

irritating but nutritious diet during attack, ] 

480 
Aconite, with a diaphoretic to control fever, | 

480 
Alkaline and astringent sprays, followed by 

insufflations of anodyne and astringent 

powders, 480 
Bromide of sodium or potassium, with small j 

doses of potassium cyanide, in excessive | 

cough, 480 
Calomel, small and repeated doses, followed 

by saline purges along with hot mustard ! 

foot-bath and demulcent drinks, 480 
Dover's powder, if necessary, to give rest, 480 
Iodol, insufflations, in tubercular types, 190 
Lozenges, preferable to gargles, 480 
Silver nitrate, 223 



Steam inhalations charged with benzoin, cam- 
phor, or cubebs, 480 

Tonics, woollen underwear, fresh air and 
change of climate during convalescence, 
480 

LARYNGITIS, CHRONIC, 472 

Formula for powder, as a protective to raw or 
ulcerated surfaces, 484 

Silver nitrate, strong solution, pure salt or 
mitigated stick, touched to indolent or 
granulating inter-arytenoid fissures, 484 

Vapor and powder inhalations and other 
measures, same as for subacute types, 584 

Training of voice, removal of nasal obstruc- 
tions and relief of irritation, necessary for 
cure in some cases, 484 



LARYNGITIS, SUBACUTE, 480 

Benzoin, camphor, fluid extract of cubebs, or 
tar, as inhalations, 481 

Insufflation powder— zinc sulphate and milk 
sugar, equal parts, reduced ; tannic acid 
reduced to %, with iodoform, useful in 
abraded or ulcerated surfaces, bismuth 
subnitrate or subcarbonate and morphine 
may be added if indicated ; lead acetate, 
gr. 10 to 20 to the % ounce, with a little 
morphine acetate, 482 

Lithia water, in laryngeal thickening, 482 

Potassium iodide, in small doses, long contin- 
ued, with or without arsenic, in laryngeal 
thickening, 482 

Remedies, for acute types, usually sufficient to 
effect cure, 482 

Tonics, generous diet, exercise and use of 
woollen underwear to prevent return, or 
development of chronic type, 482 

Turkish baths and friction of skin, in rheuma- 
tic or gouty cases, 482 

Zinc sulphate, ferric alum, tannic acid, or weak 
bichloride solution in spray, 481 

LEUCORRHCEA, 485 

Alum, gr. 10 to 20 to the ounce, as a vaginal 

Mash, 47 
Ammonio-ferric alum, gr. 2 to 5, in atonic 

types, 181 
Belladonna, gr. 1 to 2, Avith tannic acid, gr. 6 to 

8, applied on cotton, in disease of uterine 

cervix, 75 
Cantharidal collodion applied over groins to 

produce blister, in catarrh of Fallopian 

tubes or ovarian irritation, 486 
Goodell's prescription for, 486 
Hot sitz-bath, or vaginal injections of hot 

water, if due to uterine congestion, 321 
Hydrastis injections, if due to relaxed vagina, 

170, 171 
Iron, with tonics, in excessive lactation or 

exhausting life, prescriptions for, 485 
Myrrh, if due to uterine trouble, 220 
Potassium permanganate (drachm y 2 to water 

1 pint), as an injection, if discharge is 

foetid, 486 
Prescription for injection, 487 
Ringer's prescription for wash, 486 



620 



INDEX OF DISEASES AND REMEDIES. 



Tampon, saturated with iodoform and tannic 
acid, equal parts, sometimes of service, 
486 

White-oak bark (ounce 1 to water 1 pint), or 
tannic acid and glycerin (ounce 1 to 2 
quarts of water), as an injection, 486 

LICHEN". 

Arsenic, usually cures, 68 

Bath of sulphides, often beneficial, 276 

Cantharides, 98 

LID ABSCESS, 479 
Treatment, same as for other abscesses, 479 

LITHiEMIA. (See Gout.) 

LOCOMOTOR ATAXIA. 
Antifebrin, 33 
Antipyrine, 62 

Potassium bromide, 'to prevent laryngeal 
crises, 84 

LUMBAGO, 487 

Acupuncture, often relieves, especially if pain 

is bilateral, 296, 487 
Antifebrin ; dose, gr. 4 to 8, 487 
Antipyrine : dose, gr. 10 to 20, 487 
Chloroform liniment, 123 
Cod -liver oil, 135 
Foot-bath and Dover's powder, before retiring, 

often relieves, 4^7 
Ice-bag or ether spray to loins, if hot applica- 
tions fail, 487 
Ironing back with laundry iron, skin being 

protected by cloth or paper, very efficient, 

487 
Monobromated camphor, Avith other drugs, 

very useful, 95 
Mustard or capsicum plaster or blister, over 

painful spot, may relieve, 487 
Potassium iodide or salicylic acid, if recovery 

is slow, 487 
Turpentine, gtt. 20, said to be useful, 289 

LUPUS. 
Ichthyol ointment, 175 
Iodine, as a paint, to retard its spread, 187 
Acid nitrate of mercury, 217 

MALARIAL FEVER. 

(See Intermittent and Remittent Fevers.) 
Antipyrine, 62 

Arsenic, as a cure and prophylactic, 67 
Eucalyptus, instead of quinine when it cannot 

be borne, 157 
Gelsemium, of doubtful value, 161 
Gentian, in malaria, with dyspepsia, 162 
Hydrastis, said to be anti-malarial, 170 
Pilocarpine, may be used to abort, 193 
Quinine, the best remedy as a prophylactic 

and a cure, 127 

MANIA, ACUTE, 488 

Anaesthetics or apomorphine, in emetic dose, 
to relax muscular system, if patient is very 
violent, so that other remedies may be 
administered, 488 



Bromide of potassium, as a soporific, 84 

Cannabis indica, particularly serviceable with 
large dose of bromides, 488 

Chloral, in full doses, if kidneys are healthy, 
488 

Cimicifuga, fluid extract, gtt. 20 to 30, thrice 
daily, in cases occurring after confinement 
not based upon permanent trouble, 488 

Cold douche to head, body being in hot water, 
often of service, 488 

Hyoscine hydrobromate, gr. 1-100, when neces- 
sary to quiet patient rapidly, 488 

Morphine, in full dose, may be required to 
quiet patient, 488 

MARASMUS. 

Cod-liver oil inunctions, one of the best 
remedies, 135 

MASTITIS. (See Breast, Inflamed.) 

MELANCHOLIA, 448 

Nitro-muriaticacid, gtt. 5, after meals, if due to 
oxaluria, 488 

Phosphorus, useful in some cases due to over- 
work, 248 

MENINGITIS, ACUTE, 488 

Aconite or veratrum viride, in early stages, to 
depress circulation, 488 

Alcohol, given with food in second stage, if 
weakness exists, 490 

Belladonna, often useful, especially when 
opium and calomel are contra-indicated, 
489 

Blister in early stage, to prevent effusion ; 
also in comatose state, 489 

Bromides and chloral, best agents to allay 
nervous symptoms, 489 

Calomel, gr. % ! with opium, gr. %, every half 
hour, in early stage, until effect is mani- 
fested ; the deodorized tincture, gtt. 2 to 5, 
every two hours, or less, preferable to 
powder of opium, in some cases, 210, 489 

Ergot, in stage of exudation, 489 

Ice-bag to head, in early stage, 489 

Leeches, to nape of neck, in early stage, 489 

Milk diet, in second stage, 490 

Opium, useful in second stage, 489 

Quinine, contra-indicated, in acute stage, 489 

Venesection, in sthenic cases, in early stage, if 
aconite or veratrum viride are not at hand, 
327, 489 

MENINGITIS, CHRONIC. 

Phosphorus, 249 

MENOPAUSE. 

Bromide of potassium, in nervous disorders, 83 

Cannabis indica. alone or with aloes and iron, 
if aneemia or constipation exists, in the 
headaches of the menopause, 96 

Eau de cologne, saturated with camphor, 
locally applied, in headache or drowsiness, 
94 

Valerianate of ammonium, in nervous disor- 
ders. 53 



INDEX OF DISEASES AND REMEDIES. 



621 



MENORRHAGIA AND 
METRORRHAGIA, 457 

Bromide of potassium or sodium, gr. 10, once 
or twice daily, if bleeding is irregular, 84, 
458 

Cannabis indica, recommended, 458 

Cinnamon oil, drachm y 2 , when erigeron is not 
at hand, in oozing flow, 458 

Dry cups, over sacrum, if due to congestion, 
'458 

Ergot, fluid extract, gtt.'lO to 60, best remedy 
in active bleeding, 458 

Erigeron, oil of, minims 3 to 5, in capsule or 
emulsion, the best remedy for oozing, 458 

Hamamelis, distilled extract, drachm 1, thrice 
daily, in irregular bleeding, 458 

Monsel's solution (50 per cent.) ; if due to poly- 
pus, full strength, locally applied, 178 

Rhus aromatica, highly recommended in men- 
orrhagia, 255 

Rue, in atonic menorrhagia, 257- 

Savine. oil of, gtt. 5 to 10, in capsule or emul- 
sion, every three or four hours, as a tonic 
in menorrhagia, 265 

Turpentine, often of value, 289 

MIGRAINE, 499 
Amyl nitrite, 54 
Bromide of potassium, with caffeine, almost a 

specific, if due to eye-strain, 84 
Cannabis indica. tincture, gtt. 20, hourly, or 

extract, gr. 1-4 to %> every two hours, best 

treatment, 499 
Croton chloral, very efficient, especially if fifth 

nerve is involved, 115 
Gelsemium, with cannabis indica, to abort, .96 
Salicylic acid, of great service, in rheumatic 

types, 260 

MILK DEFICIENCY", 528 

Electricity, 529 

Treatment for intercurrent affection, if due to 
that cause. 528 

MORPHIOMANIA. (See Poisoning 
from Opium, Chronic.) 
Bromide of potassium, 84 

Phosphorus, of service in sequela? of morphio- 
mania, 248 

MUCOUS MEMBRANES, 
DISEASES OP. 

Acacia, in mucilage, as a drink, in irritation 
and inflammation of upper air-passages, 29 

Bismuth, as an astringent, to inflamed mem- 
branes, 79 

Flaxseed, as a soothing demulcent, 159 

Glycerole of aloes, valuable, locally applied to 
fissures, 49 

Opium, suppositories, gr. 1-4, useful in rectal 
inflammation, if not an acute catarrh, 235 

Pareira, useful in chronic genito-urinary in- 
flammation, 241 

Terebene, useful in subacute and chronic 
genito-urinary inflammation, instead of 
sandalwood or copaiba, 285 

Zinc sulphate, weak solution, as an astringent, 
276 



MUSCULAR STIFFNESS. 
Hot laundry iron passed over part, skin being 
protected by layers of paper or cloth, often 
relieves, 321 

MYALGIA, 490 

Ammonium chloride, if due to cold or bruises, 
490 

Camphor liniment, 94 

Chloroform liniment, 490 

Cimicifuga, fluid extract., gtt. 20 to 1 drachm , 
490 

Clove oil, added to liniment, as a counter-irri- 
tant, 132 

Iodine ointment, pure or diluted, with lard. 
490 

Iodide of potassium or salicylates, if due to 
rheumatism, 490 

Massage or good rubbing, very necessary, 490 

Potassium acetate or citrate, grs. 20, may be 
tried, 490 

Poultices, hot as can be borne, 490 

Prescription for liniment, 490 

NASAL CATARRH, ATROPHIC, 490 

Dobell's solution, as a cleansing wash ; carbolic 
acid may be increased, or thymol and eu- 
calyptus substituted for it, to relieve odor, 
491 

Galvano-cautery, or strong silver nitrate solu- 
tion, if ulcerations are present, 491 

Hydrogen peroxide, 491 

Iodine and glycerin (gr. 6 to 8 to the ounce), 
with potassium iodide sufficient to make 
solution, valuable, locally applied, 492 

Listerine, maybe added to Dobell's solution, to 
relieve odor, 491 

Potassium iodide, internally, tonics and stimu- 
lants to mucous membrane and attention 
to activity of skin, 492 

Potassium permanganate, useful ; painful if 
sensation is not entirely lost, 491 

Removal of necrosed bone, 492 

Silver nitrate and starch (gr. 1 to 10 to drachms 
2%), as an insufflation powder, or solution 
(gr. 1 to 10 to the ounce) better, in some 
cases, locally applied, 492 

NASAL CATARRH, CHRONIC, 492 

Bolton's solution or ferric alum (gr. 5 to the 
ounce), useful, in spray, in later stage, 496 

Galvano-cautery or snare, to remove hypertro- 
phic tissue remaining after acute stage, 497 

Hydrastis, dilute solution, or distilled extract 
of hamamelis and water, equal parts, use- 
ful in spray, in acute stage, 496 

Iodine and glycerin (gr. 6 to 8 to the ounce), 
with potassium iodide, sufficient to make 
solution, locally applied, 497 

Prescription for alkaline wash, 389 

Remedies for coryza, useful, instituted for a few 
days, 496 

NAUSEA. (See Vomiting.) 
Hoffmann's anodyne, when due to excessive 
use of tobacco, 168 



622 



INDEX OF DISEASES AND REMEDIES. 



Hydrocyanic acid, dilute, gtt. 20 in water, often 

useful, 171 
Lime-water, 92 

NEPHRITIS. (See Bright's Disease.) 

NERVOUSNESS. 

Camphor, as a sedative, 93 

Hops, as a sedative, 169 

Musk, useful in nervous excitement and col- 
lapse ; only to be used through crisis, 219 

Phosphorus, in nervous debility and exhaus- 
tion, 248 

"Pill of three valerianates," highly recom- 
mended, 291 

Strychnine, in functional nervous atony or de- 
pression, 230 

Sumbul. prescription for, 281 

Sweet spirit of nitre, in nervous excitement of 
fever and other states of infancy, 282 

Valerian, alone or with other drugs, 291 

NEURALGIA, 497 

Acetanilide, useful, especially with monobro- 
mated camphor, 33 
Aconite, ointment (gr. 2 to the drachm), or 

oleate of aconitine (gr. 2 to sweet oil 100), 

useful applied over painful spot, if limited 

in area ; if not, contra-indicated, 37, 499 
Acupuncture, nerve-stretching, or neurectomy 

necessary in some cases, 499 
Antipyrin, gr. 5 to 20, very useful, 498 
Belladonna, 74 
Bromide of potassium with caffeine, almost a 

specific, 84 
Camphor liniment, locally applied, to relieve 

pain, 94 
Chloralamide, 115 

Chloroform liniment, as a local anaesthetic, 123 
Cimicifuga, especially useful in ovarian types, 

125 
Cod-liver oil, 135 
Croton chloral, gr. 5 to 20, in 5-grain pills, often 

effective in brow neuralgia, 499 
Freezing parts with ether or rhigolene spray, or 

by small package of ice and salt, successful 

if nerve is superficial, 499 
Hydrocyanic acid, useful in intestinal neu- 
ralgia, 173 
Iodide of potassium, may be tried in rheu- 
matic neuralgia, 183 
Iron and arsenic, in anaemia, often necessary 

to associate with them bitter tonics and 

cod-liver oil, 497 
Kataphoresis, 326, 499 
Morphine, gr. 1-5 to 1-4, injected into painful 

spot, if localized ; not advisable in chronic 

cases, 499 
Muriate of ammonium, useful in ovarian types, 

52 
Mustard plaster, as a counter-irritant, 219 
Nux vomica or strychnine, if nerve is depressed 

by anaemia, 497 
Peppermint oil, locally applied on cloth over 

painful spot, 243 
Phenacetine, gr. 3 to 8, very useful, 498 



Phosphorus, if due to nervous exhaustion, 
498 

Prescriptions containing antipyrine with bro- 
mides and caffeine, 498 

Quinine, if due to malaria, 498 

Specific remedies, if due to scrofulosis or syph- 
ilis, 498 

Turkish bath, may relieve, if due to rheu- 
matism or gout, 323 

Veratrine ointment, locally applied over neu- 
ralgic nerve, 292 

NIGHT-SCREAMING. 

Bromide of potassium, 84 

NIGHT-SWEATS. 

Acetic acid, as a lotion, diluted one-half, 34 

Agaricin, of doubtful value, 37 

Alum dissolved in water or alcohol, efficient 
application for sponging, 47 

Belladonna, best remedy, 75 

Camphoric acid, may be tried if ordinary reme- 
dies fail, 95 

Ergot, 151 

Gallic acid, 159 

Pilocarpine, gr. 1-20 hypodermically, two hours 
before sweat, often useful, even when atro- 
pine fails, 194 

Sulphuric acid, with belladonna or morphine, 
often useful, 281 

Zinc oxide, prescription for, 239 

NIPPLES, SORE, 499 

Benzoin, tincture locally applied, 500 
Boracic acid (gr. 20 to the ounce), or mucilage 

of acacia, applied after nursing, nipple 

being dried beforehand, 499 
Breast-pump or nipple shield may be necessary 

to effect cure, 500 
Cocaine (gr. 4 to the ounce), applied and 

washed off before nursing, if breast is very 

painful, 499 
Silver nitrate stick touched to fissure, if deep 

and slow to heal, 499 
Tannin, glycerite of, locally applied, 500 

NYMPHOMANIA. 

Bromide of potassium, of great service, 83 
OBESITY, 500 

Acetic acid, harmful, 34 

Cold bath, 503 

Diet, 501 

Laxative fruits and purges, to regulate bowels, 
503 

Massage, passive movements, absolute 
skimmed-milk diet, and electricity, if ex- 
ercise is impracticable, 503 

Potassium permanganate, 244 

Saline purges, if liquid taken in drink is not 
rapidly eliminated, 503 

Turkish bath, 503 

OPIUM HABIT. (See Poisoning from 

Opium, Chronic.) 

OPHTHALMIA. (See Conjunctivitis.) 

ORCHITIS. (See Epididymitis.) 



INDEX OF DISEASES AND REMEDIES 



823 



OSTEOMALACIA. 

Phosphorus, 248 

OTOERHCEA. 
Creolin, solution (1 to 500), used with syringe, 
143 

OZJENA. 
Prescription for insufflation powder, 216 

OVARIAN TUMOR. 

Iodine, 187 

PARALYSIS AGITANS. 

Cannabis indica. to quiet tremors, 96 
Chloral, of great service, 114 

PARASITES. 

Bichloride of mercury (gr. 2 to water oz. 1) , ap- 
plied thrice daily in parasitic skin diseases, 
215 

Chrysarobin, gr. %. internally, or the oint- 
ment, with benzoated lard (1 to 4 or 5), 
locally applied ; must not be used on face, 
124 

Mercurial ointment, useful to destroy pediculus 
pubis or other parasites, 211 

Volatile or fixed oils, useful to destroy. 211 

PARTURITION. 

Castor oil, to relieve constipation, 108 
Chloral, if rigidity of os exists, 114 
Cimicifuga, 125 
Quinine, as a stimulant to uterus, 127 



PEMPHIGUS. 



Arsenic. 68 



PERICARDITIS, 503 

Aconite, to allay inflammation and quiet heart, 
37 

Alcohol, digitalis, or caffeine, if heart shows 
signs of failure, 503 

Aspiration, gradual, if exudation endangers 
life, 503 

Blister, over prsecordium, often useful, 503 

Calomel, gr. y^ with opium, hourly, to prevent 
exudation, 503 

Iodide of potassium, to aid in absorption of 
fluid, 183 

Jalap, compound powder of, gr. 20 : or elate- 
rium, gr. % ; or saline purgative, before 
breakfast, useful to remove effusion in 
some cases, 503 

Leeches, 5 to 10, over prsecordium, accompa- 
nied by large dose of veratrum viride, 
in early stage of sthenic cases, 503 

Opium, to allay inflammation, 235 

PERITONITIS, ACUTE, 504 

Aconite, preferable to veratrum viride, to de- 
press circulation, 504 

Belladonna and opium, by mouth ; if impos- 
sible, by rectum, to relieve vomiting and 
pain ; also useful in obstinate constipation 
due to muscular paralysis, 504, 505 

Lawson Tait's treatment bv salines, 505 



Leeches, 10 to 30, or mustard plaster to abdo- 
men, accompanied by opium and bella- 
donna, given as above, to relieve pain and 
vomiting in early stage, 504 

Mercury, useful only in severe acute forms due 
to traumatism or other causes, 504 

Pancreatinized milk, frequently given, and 
absolute rest, during attack, 505 

Turpentine stupes, or turpentine, drachm 1 : 
milk of asafcetida, oz. 3 ; and water, oz. 4, 
as an enema, if tympanites is present. 
505 

Venesection, valuable in early stage, if case is 
sthenic, 327 

Veratrum viride, inferior to aconite, in early 
stage, 504 

PERNICIOUS MALARIAL 
FEVER, 508 
Quinine, large doses, in solution, by mouth, 
rectum, or hypodermically, 508 

PHARYNGITIS. 

Cocaine, gives temporary relief, after-effects 
bad, 133 

Cubebs, troches of, used in chronic types, 145 

Monsel's solution, pure or diluted one-half 
with glycerine, applied on pledget of cot- 
ton or camel's-hair brush, 179 

Silver nitrate, solution, in varying strength, 
locally applied, 223 

PHTHISIS. (See Tuberculosis.) 
PLEURITIS, OR PLEURISY, 508 

Aconite or veratrum viride, preferable to vene- 
section, in early stage, 508 

Aspiration, when hydragogue purges fail to 
remove effusion, 508 

Blisters, useful in early stage ; also during 
stage of effusion, 508, 509 

Calomel, in sthenic cases, to prevent exudation, 
509 

Cantharidal blister, two inches below axilla, 
aids absorption of effusion. 316 

Digitalis or alcohol, if pulse weakens in second 
stage, 509 

Dry cups, contra-indicated over diseased area, 
may be employed over back, 508 

Elaterium or jalap, useful to remove effusion, 
149, 509 

Gelsemium, 161 

Ice-poultice or jacket, used with success in 
sthenic cases, 306 

Iodine, locally applied, to abort, and aid ab- 
sorption of fluid, 187 

Iodide of potassium, used in chronic stage, to 
aid absorption, 183 

Saline purges, in second stage, to remove effu- 
sion, 509 

Wet cups, useful in early stage, over inflamed 
spot, 508 

PNEUMONIA, 509 
Aconite, preferable to veratrum viride, in early 

stage, in children, 511 
Alcohol, inferior to digitalis, as a cardiac 

stimulant in second stage, 516 



624 



INDEX OF DISEASES AND REMEDIES 



Antimony, should only be used in sthenic cases. 

513 
Antipyrine, of great value if fever is excessive, 

61 
Blisters applied to one side of congested spot, 

in first stage; immediately over spot in 

stage of resolution, 518 
Cardiac stimulants, if secondary attack is 

superimposed on first, 518 
Cayenne pepper, a valuable counter-irritant, 

514 
Chloral, not advisable, 513 
Cups, dry and wet, in first stage ; also in 

secondary attack superimposed on first, 

514, 518 
Digitalis, tincture, gtt. 5, every four hours, 

accompanied by strychnine, gr. 1-20, care- 
fully watched, in second stage, 514 
Expectorants must be stopped, if secondary 

attack is superimposed on first, 518 
Gelsemium. not advisable, 513 
Ice-poultice or jacket highly recommended, 

in first stage of sthenic cases, 306, 514 
Leeching, bleeding, cupping or cardiac seda- 
tives, in sthenic cases, if secondary attack 

superimposed on first, 518 
Mustard plaster to chest in first stage ; to feet, 

in secondary attack superimposed on first, 

518 
Oxygen inhalations, if asphyxia threatens, 

519 
Phosphorus, 248, 249 
Pilocarpine, hypodermically, only to be used 

in earliest stage, 513 
Poultices, useful in second and third stage, 519 
Prescriptions, to loosen cough of second stage. 

517, 518 
Quinine, gr. 2, thrice daily, in suppository, in 

lobar pneumonia of children, 128 
Turpentine stupe, in first stage ; also in second- 
ary attack superimposed on first, 514, 518 
Venesection, in early stage of sthenic cases, 

cardiac depressants preferable, 327, 517 
Veratrum viride, preferable to aconite, in early 

stage, in adults, 511 

PLEURODYNIA. (See Neuralgia.) 

POISONING FROM 
Acetanilide. 

Supportive measures, stimulants, external 
heat, belladonna to maintain blood pres- 
sure, strychnine to counteract respiratory 
failure, and oxygen inhalations to over- 
come cyanosis, 32 

Acetate of Zinc. 
Treatment same as for gastro-enteritis, 34 

Acetic Acid. 

Large amounts of milk, alkaline liquids, and 
general treatment for gastro-enteritis, 34 

Aconite. 
Keep patient in prone position with feet 
higher than head. Hot applications ; 



emetics contra-indicated ; evacuate stom- 
ach by siphon or stomach-pump. Ether 
hypodermically, followed by alcohol and 
this by digitalis. Artificial respiration and 
amyl nitrite, a few whiffs, no more, if 
heart fails, 

Alcohol, Acute. 

External heat and digitalis hypodermically, 
in coma, if heart fails. Belladonna, if 
skin is relaxed and clammy, and counter- 
irritation to nape of neck, for brain symp- 
toms. After-treatment, ammonia, spices, 
spirit of Mindererus ; emollients in gas- 
tritis. Ice, aconite, or ipecac, in minute 
dose, and counter-irritation for vomiting. 
Jalap, gr. 40, elaterium, gr. 1-6, or calomel 
and salines, as purgatives, 39 

Alcohol, Chronic. 

Withdrawal of drug, at once or gradually. 
Highly seasoned broths, predigested foods, 
and morphine or coca, in small dose, if 
weakness is marked. Capsicum prescrip- 
tions (pages 41, 99), 41 

Antimony. 
Large doses of tannic acid, external heat, alco- 
hol, digitalis, and opium hypodermically, 
if respiration is not too feeble. Prone posi 
tion, the patient vomiting into towels. 
Stomach-pump, if vomiting is absent, 57 

Antipyrine. 

Maintain bodily heat, stimulants, atropine, 
and oxygen inhalations, if cyanosis is 
alarming, 61 

Arsenic, Acute and Chronic. 

Stomach-pump, external heat, stimulants, and 
the chemical antidote, hydrated sesquiox- 
ide of iron and magnesia. Magnesia also 
useful by itself. Opium should follow anti- 
dote to allay pain, and large draughts of 
water to flush kidneys and dilute poison. 
For chronic poisoning, iodide of potassium, 
tonics, electricity, and out-of-door life, 70, 
71 

Carbolic Acid. 

Soluble sulphates, as Epsom or Glauber salts, 
warm mucilgainous drinks, hot applica- 
tions to extremities, digitalis, strychnine, 
and counter-irritation over abdomen. 
Emetics and stomach-pump should be used 
if possible, 103 

Carbon Disulphide. 

Potassium bromide and chloral, if convulsive 
disorders exist, and circulatory stimulants 
if failure threatens, 105 

Chloral. 

External heat, emetics in early and stomach- 
pump in later stages. Strychnine or atro- 
pine to stimulate respiration. Digitalis 
preceded by ether, ammonia, brandy, or 
whiskey. Prone position, feet being ele- 
vated, 113 



INDEX OF DISEASES AND REMEDIES. 



^0 



Chloroform. 

Artificial respiration, ether hypodennieally, 
and hot brandy. Poles of battery with 
rapidly interrupted current swept over 
body, not over diaphragm or phrenic nerve. 
Place patient with head downward. Atro- 
pine, strychnine, and digitalis to stimulate 
heart and respiration, 121 

Colchicum. 

Tannic acid, emetics, and stomach-pump. Opi- 
um to relieve pain and oils to soothe in- 
flamed mucous membranes. Atropine and 
stimulants if collapse comes on, 13S 

Conium. 

Emetics or stomach-pump, strychnine as a ner- 
vous and respiratory stimulant, external 
heat and cardiac stimulants, if circulation 
fails, 141 

Copper. 

Yellow prussiate of potassium, sweet oil, white 
of eggs ; followed instantly by emetics or 
stomach-pump. If emesis or purgation is 
present emetics are contra-indicated, and 
mustard plaster over abdomen and opium 
internally, are to be employed, 142 

Croton Oil. 

Treatment same as gastro-enteritis, 144 

Digitalis. 

Tannic acid as a chemical antidote, emetics or 
stomach-pump, external heat to abdomen 
and aconite as a physiological antidote. 
Maintain horizontal position, 148 

Elaterium. 

Treatment same as gastro-enteritis, 150 

Ether. 

Artificial respiration, place body with head 
downward if face is pale, strychnine hypo- 
dermieally, atropine, digitalis, or intrave- 
nous injection of ammonia, frictions and 
hot applications, 124 

G-elsemium. 

Emetics and stomach-pump, digitalis, atropine, 
and ammonia as cardiac stimulants, exter- 
nal heat, strychnine, and atropine for re- 
spiratory centre, 161 

Iodine. 

Emetics or stomach-pump, large amounts of 
starch, hot applications, and hypodermic 
injections of alcohol, ammonia, atropine, 
digitalis, or strychnine, 185 

Lead, Acute. 

Epsom or Glauber salts, in large amounts, 
emetics or stomach-pump, if vomiting pro- 
duced by the drug has not rid stomach of 
all poison. Hot applications and opium to 
relieve pain, 198 



Lead, Chronic. 

Jala]) and calomel with opium, and alum, gr. 
2, with opium or morphine, in full dose, 
valuable in lead colic. Blister to back of 
neck, revulsives and pilocarpine in cere- 
bral inflammation. Iodide of potassium 
to eliminate lead. Strychnine in progres- 
sive paralysis. Electricity and baths of 
sulphurets of potassium, to restore lost 
function, 199 

Mineral Acids. 

Alkalies, such as magnesium, lime, white-wash, 
soap, white of egg, external heat, oils and 
opium, to relieve irritation, 171, 225, 227, 280 

Monsel's Solution. 
Soap, 179 

Nitrate of Silver, Acute. 

Common salt as the chemical antidote, opium 
and oils to allay irritation, large amounts 
of milk, soap, and water, 222 

Nitrate of Silver, Chronic. 

Iodide of potassium, to aid in eliminating poi- 
son, 222 

Nux Vomica and Alkaloids. 
Inhalations of aniyl nitrite, to prevent convul- 
sive tendencies, at the same time use stom- 
ach-pump. Tannic acid followed by phys- 
iological antidotes, potassium bromide, gr. 
60, with chloral, gr. 20. If convulsions 
prevent swallowing, chloroform patient 
carefully and give antidotes by rectum in 
starch-water. Amyl nitrite, hypodermi- 
eally, if relaxation does not occur, 229 

Opium, Acute. 

Emetics or stomach-pump, tannic acid, black 
coffee, electricity, and other measures to 
keep patient awake. Atropine, hypoder- 
mieally, if respiration fails. Alcohol, am- 
monia, and external heat. Artificial respi- 
ration may be necessary, 233 

Opium, Chronic. 

Decrease a sixth or fourth of customary amount 
each twenty-four hours. Cocaine not ad- 
visable, as the cocaine-habit may be estab- 
lished. Digitalis if heart fails, 234 

Phosphorus. 

Sulphate of copper as the chemical antidote , 
acts as an emetic if given in excess, 248 

Physostigma. 

Atropine as a physiological antidote, external 
heat, and cardiac and respiratory stimu- 
lants, 250 

Scammony. 

Treatment same as for gastro-enteritis, 

Tobacco. 

Strychnine, cardiac stimulants, external heat, 



and atropine, 287 



40 



626 



INDEX OF DISEASES AND REMEDIES. 



Veratrum Viride. 

Prone position, head higher than feet, atropine, 
strychnine, external heat, and cardiac 
stimulants, 293 

POST-PAETUM HiEMOEKHAGE, 
461, 527 

Auto- transfusion, or actual transfusion of weak 

salt solution, necessary in some cases, 528 
Beef-tea, % pint, and morphine, gr. % hypo- 

dermically, after reaction is established, 

528 
Enema, of hot water, 1 pint, after cessation of 

bleeding, 528 
Ergot, as a cure and prophylactic, 151 
Ether, hypodermically, if symptoms of shock 

are manifested, 528 
Hirst's method of controlling, 527 
Suture, if due to laceration, 528 



PRIAPISM. 



Hops, 169 



PROLAPSUS ANI AND RECTI. 

Injection of cold or hot water, often relieves, 
311 

PROSTATITIS, 446 

Cold-water injections and perineal douches, 
312, 446 

Local treatment to prostatic urethra, and use 
of cold steel-sounds in chronic types, 447 

Perineal incision, to evacuate pus, if abscess 
forms, 447 

Rest in bed, regulation of bowels, leeches to 
perineum, medication to render urine alka- 
line, and morphine hypodermically or in 
suppository, 446 

Soft catheter, allowed to remain in bladder, if 
retention of urine is persistent, 446 

PROSTATORRHCEA. 

Cantharides, 98 



PRURIGO. 



Cantharides, 



PRURITUS, 519 

Alum solution as a wash in pruritus vulvas, 47 

Arsenic, quinine, bitter tonics, cod-liver oil, 
alkaline diuretics or mineral waters in de- 
bility and avoidance of condiments, if 
mouth of vagina or urethra is affected, 520 

Calomel and lard (1 drachm to the ounce), 
locally applied, 213 

Cocaine, relieves temporarily, 520 

Cold douche and injections highly recom- 
mended in pruritus ani and vulvae, 311, 312 

Goulard's extract, dilute, useful in pruritus 
pudendi, 200 

Hydrocyanic acid, locally applied, prescription 
for, 173 

Prescription for lotions and ointments, 520 

Salicylic acid, prescription for, 260 



Silver nitrate (gr. 20 to the ounce), locally ap- 
plied, preceded by cocaine, if itching is 
intense; a 4 to 6-grain solution may re- 
lieve itching of pruritus pudendi, ani and 
vulvse, 224, 520 

Sodium bicarbonate or borax (1 drachm to the 
pint) as a wash, relieves temporarily, 520 

Tobacco, 288 

PSORIASIS. 

Anthrarobin, 55 

Aristol, 65 

Arsenic, 68 

Baths of sulphides, very useful, 276 

Chrysarobin, gr. % internally, or the ointment 

with benzoated lard (1 to 4 or 5) locally 

applied, face excepted, 124 
Gallic acid ointment, 159 
Resorcin, prescription for, 254 
Tar, locally applied, 251 

PTYALISM. 

Alum, applied on swab, in mercurial ptyalism, 

47 
Belladonna, in idiopathic or mercurial types, 

75 

PUERPERAL. DISEASES, 521 
For treatment, see special titles. 

PUERPERAL FEVER, 521 

Antipyretics, best abstained from as long as 
possible, 522 

Bichlorate of mercury (1 to 2000), or creolin 
(2 per cent.) solutions, as antiseptic injec- 
tions, 521 

Boric acid, creolin (2 per cent.), or bichloride 
(1 to 8000) solutions as injections into blad- 
der, to prevent septic cystitis, 524 

Curette or placental forceps, to remove mem- 
branes if fever continues after antiseptic 
injections, 521 

Epsom salts, concentrated solution, 2 drachms 
every fifteen minutes, if peritonitis devel- 
ops, 523 

Laparotomy, occasionally saves life, if septic 
peritonitis develops, 522 

Nutriment in large amounts and alcoholic 
stimulants, if symptoms of systemic inva- 
sion arise, 522 

Silver nitrate (gr. 40 to 60 to the ounce) locally 
applied, to unhealthy ulcerated wounds ; 
zinc chloride solution may be necessary, 
523 

Veratrum viride, 294 

PURPURA HEMORRHAGICA. 

Turpentine, 289 

PYELITIS. 

Buchu, in chronic types, 87 

Cantharides, 98 

Copaiba, 141 

Juniper, as a tonic in chronic types, 195 

Uva ursi, 290 



INDEX OF DISEASES AND REMEDIES. 



627 



QUINSY. 

Aconite, in early stage, 37 
Salicylic acid, gr. 3 hourly, acts as a specific, 
especially if due to rheumatism, 260 

REMITTENT FEVER, 532 

Antipyrine, or cold pack, if fever is excessive. 
533 

Eupatorium, 158 

Monsel's salt, or gallic or tannic acid, if intes- 
tinal haemorrhage occurs, 533 

Morphine, spirit of chloroform, or aconite in 
sthenic cases, to control vomiting, 533 

Quinine, gr. 20 to 30, preceded by calomel, gr. 
3 to 4, if not retained, administer by rec- 
tum, or hypodermically, with divided doses 
of Seidlitz powder, by mouth, 532 

Tonics, potassium salts, to regulate kidneys, 
and purgatives, if necessary, during con- 
valescence, 533 

Turpentine stupe, if belly is tender, 533 

RHEUMATISM, ACUTE 
ARTICULAR, 533 

Aconite, or veratrum viride, useful at onset of 
inflammation in sthenic cases, 533, 534 

Alcohol, in depression, 534 

Ammonium bromide, 51 

Antipyrine, gr. 10 to 20, or antifebrin, gr. 4 to 
8, often very valuable, 535 

Benzoic acid, drachm 2 to 3. daily, said to be 
a specific, 77 

Bicarbonate or citrate of potassium, gr. 20, in 
water, every five hours, in obstinate cases, 
536 

Blisters over joints, useful after systemic dis- 
turbance is past, 537 

Camphor liniment, 94 

Capsicum plaster, 100 

Cimicifuga, shortens attack and relieves pain 
in some cases, 536 

Cold pack, if fever threatens life, 314 

Ice-cold compress, may relieve inflamed joints, 
534 

Iodine, ointment or tincture, painted over 
parts, 537 

Ichthyol ointment, valuable applied to joints, 
prescription for, 537 

Lemon or lime juice, or citric acid, beneficial 
in nearly all cases, 131, 536 

Oil of gaultheria, useful, as a substitute for 
salicylic acid, 536 

Potassium iodide, useful in subacute or obsti- 
nate types, prescription for, 536 

Potassium nitrate, 221 

Rhus toxicodendron, especially useful for 
night pains, 536 

Salicylic acid, gr. 20, thrice daily, if untoward 
symptoms arise must be stopped. 534 

Sodium bicarbonate (gr. 20 to the ounce), ap- 
plied on lint to inflamed joints, 534 

Salol, useful as a substitute for salicylic acid, 
dangerous in large doses, 537 

Sulphur, 279 

Yeratrine ointment, useful locally applied to 
joints, 537 



RHEUMATISM, CHRONIC. 

Arsenic, useful in some cases, 68 
Baths of sulphides, often useful, 276 
Cimicifuga, sometimes relieves, 125 
Citrate of potassium or sodium, gr. 30 to 60, be- 
fore retiring, 260 
Cod-liver oil, internally, in weakness or an- 
aemia, also useful rubbed into joints, 537 
Counter-irritation, same as in acute types, 537 
Ichthyol, the best remedy for joints, 539 
Iodine, locally applied, 187 
Liniments, j>rescrirjtion for, 538 
Ointments, prescriptions for, 538, 539 
Potassium iodide, colchicum and sarsaparilla , 

usually indicated ; see prescription, 536 
Turkish or Russian baths, very valuable, 323, 

538 
Veratrine ointment, gives greatest relief in 
some cases, prescription for, 538 

RHEUMATISM, MUSCULAR. 

Burgundy pitch, a mild local remedy, 250 
Dover's powder, in conjunction with hot drinks 

and hot foot-bath, often cures, 236 
Mustard, as a counter-irritant, 219 
Veratrine ointment, locally applied, 292 

RHINITIS. 

Creolin (1 to 1000), as a nasal douche, 143 
Fluid cosmoline, in spray, 244 
Potassium permanganate, solution, in foetid 
rhinitis, 244 

RICKETS. 

Cinchona, for child of one year or more, pre- 
scription for, 539 

Cod-liver oil, prescription for, 540 

Cool sponging or rubbing with salt and whis- 
key (1 drachm to the pint), useful at night, 
541 

Iodide of iron, syrup of, if scrofulous tendency 
or ansemia exisis, prescriptions for, 540 

Lime salts, phosphorus, zinc phosphate and 
physostigma, as bone tonics, 539 

Massage and passive movements, 541 

Mineral acids and simple bitters, as digestive 
tonics, 539 

Nux vomica, rarely given because of bitter- 
ness, 540 

Phosphate of lime or sodium, gr. 1 to 2, in 
child's milk, 541 

Phosphorus, prescriptions for, 540, 541 

Quinine, cod-liver oil, nux vomica, and iron as 
general tonics, 539 

Sodium and lime salts, useful in nursing and 
pregnant women, 540 

RINGWORM. (See Tinea Circinata.) 
SATYRIASIS. 

Potassium bromide, one of the best remedies. 
83 

SCABIES. 
Sulphur, the best remedy, 279 



628 



IXDEX OF DISEASES AND REMEDIES. 



SCARLET FEVER, 541 

Aconite, harmful, 37 

Alcohol, indicated in collapse, 543 

Antipyrine or antifebrin, may produce collapse 

in large doses, 543 
Bromide of sodium with chloral, useful when 

convulsion ushers in attack, 543 
Carbolic acid (gtt. 2 to olive oil oz. 2), benzoated 

lard, vaseline, cosmoline, or almond oil, 

useful, locally applied, to allay itching, 

544 
Chloral, very useful, prescription for, 542 
Chlorate of potash, locally applied, by spray or 

swab, in sore-throat, 544 
Cold sponging, useful ; pack must be employed 

if fever is excessive, 543 
Ice bag or rubber head coil, to head, if very 

hot, 543 
Ice, applied externally and held in mouth, to 

prevent swelling of throat, 543 
Jalap, compound powder, with potassium bi- 

tartrate, or hot dry applications, to pro- 
duce sweat in nephritis, 544 
Juniper, in later stages, if there is renal atony, 

195 
Pilocarpine, best agent to produce sweating in 

nephritis ; contra-indicated if heart is 

weak, 544 
Quinine, unsuccessful in most cases, 543 
Salicylic acid, highly recommended, prescrip- 
tion for, 541 
Strychnine, iron, simple bitters, quinine, or 

Basham's mixture, in convalescence, 544 
Warm, wet pack, useful to bring out rash, 544 
Water, pure, as Vichy or Poland, in large 

amounts, 542 

SCIATICA, 545 

Acupuncture, recommended, 295, 545 
Antifebrin and antipyrin, may prove useful, 

545 
Cod-liver oil, of service in obstinate cases, 545 
Chloroform, deeply injected over exit of nerve, 

a favorite remedy, 545 
Ether or rhigolene, sprayed on part, often effec- 
tive, 545 
Kataphoresis, may be tried, 545 
Liniments for rheumatism may be tried, 538 
Morphine, injected over course of nerve, 545 
Massage of nerve with glass rod, 545 
Nerve-stretching, necessary in some cases, 545 
Potassium iodide, 183 

Potassium bitartrate or citrate, gr. 40, thrice 
daily, in plenty of water, to regulate kid- 
neys, 545 
Remedies for rheumatism, often relieve, 545 
Salicylic acid, 260 
Sulphur, 279 

SCLERITIS, 546 

Atropine, boracic acid, and hot- water com- 
presses, to control pain in early stage, 546 

Eserine, with pilocarpine sweats or cautery, in 
stubborn episcleritis 

Yellow oxide ointment, associated with mas- 
sage, to subdue infiltration, 546 



SCLEROSIS. 

Antipyrine, 62 
Nitrate of silver, 223 

SCROFULOSIS, 546 

Arsenic or corrosive sublimate, useful if ansemia 
is present, prescriptions for, 547 

Calcium chloride, 90 

Cod-liver oil, the best remedy, 546 

Diet and exercise, 546 

Excision, or scraping gland and packing with 
iodoform gauze if other treatments fail, 547 

Ichthyol ointment, useful, rubbed into per- 
sistent enlargements ; prescription for, 547 

Iodine ointment and lard, equal parts, rubbed 
into glands , stopping at first sign of redden- 
ing or fluctuation, 547 

Iron, syrup of the iodide, in aneemia, prescrip- 
tion for, 546 

Lacto phosphates or hypophosphates, useful 
with cod-liver oil in young children, 546 

Phosphate of sodium or lime, if glands are 
breaking down, 547 

Sulphide of calcium, if suppuration is active, 
547 

SCURVY, 547 

Citric acid, if lemon, juice is not obtainable, 

131, 547 
Diet, 547 
Lemon or lime juice, particularly indicated, 

547 

SEA-SICKNESS. 

Bromides, the best prophylactics, 84 

SEAT-WORMS. (See Worms.) 
SHOCK, 548 
Alcohol, 39 

Atropine, gr. 1-60 to 1-50, hypodermically, with 
hot applications, very useful in first or 
second stage, 549 
Digitalis, valuable as an adjuvant to atropine, 
549 

SKIN" DISEASES. 

Arsenic, in dry scaly types, 68 

Cod-liver oil, in strumous types, 135 

Copper sulphate, gr. 1-10, thrice daily, if arsenic 
is not well borne, 142 

Corrosive sublimate, oz. %, and ammonium 
chloride, oz. 1, useful, added to bath in 
syphiloderm, 215 

Hydrocyanic acid, in itching types, prescrip- 
tion for, 173 

Ointment of yellow oxide and lard, in equal 
parts, a useful application, 216 

Petrolatum, as an emollient dressing, 244 

Tar and suet, equal parts, locally applied, ex- 
cept on face, 251 

Unguentum hydrargyri ammoniati, 2J6 

Zinc oxide ointment, 239 

SMALLPOX, 549 

Aconite, with spirit of nitre and Mindererus, 

useful as a fever mixture, 549 
Antipyrine or antifebrin, to control headache 

and backache, 549 
Brandy and whiskey, if pulse fails, 550 



INDEX OF DISEASES AND REMEDIES. 



629 



Bromides and chloral, in insomnia ; latter used 

carefully, 549 
Carbolic acid and sweet oil (1 to 100), as an 

ointment to check irritation, 550 
Chlorate of potassium, Avith tincture of myrrh, 

as a mouth-wash, 550 
Flexible collodion, glycerite of starch or simple 

cerate, locally applied, to prevent itching, 

550 
Iron, tincture of the chloride, to give strength 

and act as a specific, 550 
Silver nitrate, locally applied, to prevent pit- 
ting, 223, 550 

SOEDES. 
Glycerin and water, equal parts, useful as a 
mouth- wash, 164 

SORES. 

Black wash, useful for syphilitic sores, 216 
Camphor, locally applied, as a stimulant in 

indolent sores, 94 
Charcoal, applied to old sores, as a deodorant 

and antiseptic, 104 
Cold cream, as an emollient dressing, 256 
Iodoform, gr. 20, with oil of eucalyptus, oz. %, 

as a dressing for syphilitic sores, 189 
Petrolatum, as an emollient dressing, 244 
Potassium permanganate (gr. 60 to the pint), 

as a wash, 244 
Quercus alba, powdered, as a poultice, to 

check discharge, 254 
Red or yellow oxide of mercury, with chalk, 

equal parts, a good dressing for syphilitic 

sores, 215 
Sulphuric acid, sometimes used as an eschar- 
otic in venereal sores, 280 
Zinc oxide ointment, 239 

SORE-THROAT. 
Aconite, in early stage, 37 
Alum (gr. 20 to the ounce), locally applied on 

swab, 46 
Belladonna, of greatest service in some cases, 76 
Capsicum, tincture of, and glycerin, equal 

parts, locally applied on a swab, 100 
Carbolic acid (1 to 100), in spray, in ulcerated 

types, 104 
Catechu, as a gargle or in troches, 110 
Copper sulphate (gr. 4 to the ounce), often of 

service in relaxed sore-throat, 143 
Hydrogen peroxide (2 per cent, strength), in 

spray, in foetid types, 240 
Kino, as a gargle, 196 
Myrrh, tincture of, diluted one-half, as a 

gargle in ulcerated types, 220 
Quercus alba, useful as a gargle, 253 
Quinine (gr. 1 to 2 to the ounce), in spray, in 

foetid sore-throat, 128 
Rhus glabra, Avith glycerin and water, useful 

as a gargle, 256 

SPASMS. 

Belladonna, useful in urethral, anal, and 

vesical spasms, 75 
Cannabis indica, useful in vesical spasm, 96 
Conium, useful, if due to irritation of nerve- 
trunk, 140 



Ether, inhalation, relieves local spasms, 156 
Nitrite of amyl, of service to relax, 54 

SPERMATORRHOEA. (See Emissions.) 

SPRAINS. 

Arnica, 65 

Camphor liniment, 94 

Cold applications, useful in sprained ankle, 305 

Hot foot-bath. i>rolonged for hours, very useful, 
in sprained ankle, 321 

Ichthyol ointment, Avell rubbed in, A'erv use- 
ful, 175 

Lead-Avater and laudamim, 200 

Soap liniment, 270 

Soap plaster, used as a support to sprained 
joints, 270 

Turpentine liniment, 290 

STINGS AND BITES, 550 

Ammonia or alkaline liquids, locally applied 

to neutralize poison, 550 
Carbolic acid (1 to 50 or 100), sponged over part, 

useful in mosquito-bites, 550 
CorrosiA r e sublimate, with flexible collodion 

(1 to 1000), painted over part ; salicylic 

acid a useful addition, 550 
Ligature, or cleansing of Avound, at once, to 

prevent absorption in snake-bite, 550 
Potassium permanganate, applied and injected 

around snake-bite, folloAved by alcohol in 

full dose, 550 
Vinegar, dilute, locally applied, often relieves 

insect-bites, 550 

STOMATITIS. (See Aphthous 
Stomatitis.) 

STYES, 551 
Boracic acid (saturated solution), collodion 
(ethereal solution), or red or yelloAV oxide 
of mercury salve (gr. 8 to the drachm), 
locally applied, to abort, 551 
Calcium sulphide, if they tend to return, 551 
Hot compresses, to alleA'iate pain, 551 
Incision, as soon as pus forms, 551 
Tonics, if general health is poor, 551 

SUBINVOLUTION OF UTERUS. 

(See Involution, Anomalies of.) 

SUNBURN. 

Almonds, in emulsion, 44 

SUNSTROKE, 551 

Antipyretics, almost useless, 552 

Hot baths (105° to 110° F.) or hot botttles or 
bricks, in heat exhaustion, 552 

Ice application to chest, back, and abdomen, 
as quickly as possible, in thermic fever, 
551 

Salicylic acid, quinine, and similar drugs con- 
tra-indicated, 552 

Tonics, during convalescence in heat ex- 
• haustion, 553 

Venesection, best treatment, if meningitis 
threatens, after thermic fever, 552 

Veratrum viride may be used if meningitis 
threatens, 552 



630 



INDEX OF DISEASES AND EEMEDIES 



SYNCOPE. 

Ammonia, if due to shock or indigestion, 49 

SYNOVITIS. 

Carbolic acid (2 per cent, strength), as an in- 
jection in chronic types, 104 
Counter-irritation, 315 

SYPHILIS, 553 

Bismuth and calomel, as a dusting powder, or 
bichloride solution (1 to 2000), locally ap- 
plied to mucous patches about genitalia, 555 

Calomel, gr. %, every two hours, for cephal- 
algia, 555 

Cod-liver oil, useful in advanced cases, 135 

Expectant plan of treatment, 553 

Iodides, followed, if necessary, by mercury, 
recommended by some, 554 

Iodoform, gr. 1 to 5, internally in tertiary 
stage, and the ointment applied to ulcers, 
very useful, 190, 557 

Mercury, at beginning of secondary stage, fol- 
lowed later by the iodides, the most com- 
monly accepted treatment, 554 

Mercury, with chalk, chiefly employed in in- 
fantile syphilis, 211 

Ointments and washes of mercury, and hot 
applications to combat surface eruptions, 
555 

Prescription for blue mass and iron , 556 

Prescription for potassium iodide and mercury, 
to be used after first eighteen months, 555 

Pressure bandage and mercurial inunctions 
for periostitis, 555 

Russian baths highly recommended, 325 

Sarsaparilla, a useful adjunct to potassium 
iodide, 183 

Shampooing and local application of croton 
oil or cantharides, as a lotion, to combat 
alopecia, 555 

Silver nitrate, copper sulphate, chromic acid 
solution (20 per cent-), or acid nitrate of 
mercury, locally applied to mucous patches 
in mouth, 555 

Stillingia, used as an aid to other drugs, 274 

Tonic and general treatment, 557 

Vapor baths, hypodermic injections, or inunc- 
tions, useful modes of applying mercury, 
if it cannot be taken by mouth, 554, 555 
SYSTEMIC STRAIN. 

Quinine, gr. 2 to 4, useful to prevent exhaus- 
tion, following physical and mental strain, 
128 
Opium, useful in prolonged physical strain, 
236 

TABES DORSALIS. 

Chloralamide, 115 

TEETHING. 
Bromide of potassium, to prevent convulsions, 
84 

TETANUS. (See Poisoning from 
Strychnine.) 
Amyl nitrite, to relieve and prevent, 54 
Chloral and bromide of potassium, by mouth 

or rectum, 114 
Physostigma, of moderate value, 250 



TINEA CAPITIS. 
Lime-water, locally applied, 92 

TINEA CIRCINATA. 

Borax, strong solution, locally applied, 80 
Iodine, applied with camel's-hair brush, 187 
Turpentine, useful, applied with a brush, 290 

TINEA TARSI. 

Copper, crystal, or weak solution, applied to 
diseased eyelid, 143 

TINEA TONSURANS. 
Borax, strong solution, locally applied, 80 
Iodine, applied with camel's-hair brush, 187 
Oil of cajuput, applied pure, 89 

TOE-NAIL, INGROWING. 

Absorbent cotton, soaked in strong alum solu- 
tion, and inserted under nail, 47 

Liquor potassse, to soften nail prior to packing 
with cotton or partial evulsion, 203 

TONSILLITIS. 

Alum stick, deeply applied, 47 

Glycerin and tincture of capsicum, equal 
parts, applied by swab, 100 

Hydrogen peroxide (2 per cent, strength), in 
spray, in ulcerative types, 240 

Iron, tincture of the chloride, locally applied, 
177 

Monsel's solution, pure, applied with camel's- 
hair brush, 179 

TOOTHACHE. 

Creasote, applied on cotton, often relieves, 144 

Oil of cloves, inserted into cavity on cotton, 
132 

Oil of peppermint, applied on cotton, 243 . 

TORPOR. 

Ammonium chloride, in hepatic torpor, 52 

Euonymus, in mild hepatic torpor, 157 

Lactophosphates and hypophosphites, useful 
in hepatic torpor, 91 

Nitro-hydrochloric acid, in torpor of liver, 227 

Oxygen water, after meals, useful in systemic 
torpor, 240 

Taraxacum, in hepatic torpor, 284 

Russian and TurkisU baths, useful in torpidity 
of skin and kidneys, 322 

Potassium acetate, exceedingly useful in hepa- 
tic torpor, 34 

TORTICOLLIS. 

Belladonna, injected into muscle, 75 

Gelsemium, 161 

TUBERCULOSIS, 

Acetanilide, generally acts unfavorably, 34 
Almonds, essential oil of, recommended in 

cough, 43 
Alum (gr. 10 to 20 to the ounce), or sulphuric 

acid (1 drachm to the pint), useful sponged 

over body in night-sweats, 563 
Antipyrine, harmful, 61 
Arsenic, in phthisical tendencies, 68 
Atropine, gr. 1-50 to 1-60, hypodermically, in 

excessive night-sweats, 563 



INDEX OF DISEASES AND REMEDIES. 



631 



Blister, small, useful over new pleuritic spots, 
563 

Cannabis indica, % 

Carbolic acid (gtt. 5 to 10 to tbe ounce), in 
spray, 103 

Chloroform, spirit of, used by inhaler, often 
relieves cough, 562 

Climatic treatment, 559 

Cod-liver oil, rules for its use, 561 

Codeine, recommended in excessive cough, 137 

Creasote, often relieves cough and discomfort, 
internally, in spray, or by inhaler, prescrip- 
tion for. 562 

Glycerin and water, equal parts, with lemon- 
juice, useful as a mouth-wash, 169 

Hydrogen peroxide (2 per cent, strength), in 
fine spray, 240 

Iodine, useful, painted over new pleuritic spots, 
563 

Lactophosphates and hypophosphates, useful 
in some cases, 90 

Morphine and wild cherry bark, in cough, pre- 
scription for, 562 

Opium, may be given in last stage, to relieve 
pain and discomfort, 236 

Oxygen, inhalations in dyspnoea, 239 

Pilocarpine, gr. 1-20, one to two hours before 
sweat, sometimes arrests ; if it or atropine 
fails alone, give them together, 563 

Potassium cyanide, in excessive cough, pre- 
scription for, 145 

Silver nitrate (gr. % to 2 to the ounce), in spray, 
may be tried in laryngeal types, 223 

Strychnine, in dyspnoea, 230 

Sulphuric acid, internally, may relieve night- 
sweats, 563 

TYPHOID FEVER, 563. (See Fever.) 

Acetanilide, generally acts unfavorably. 32 
Alcohol, useful throughout course of disease, 

564 
Asafoetida, by rectal injections, in tympanites, 

71 
Calomel, gr. %, every fifteen minutes, till gr. 1 

is taken, followed by magnesium sulphate, 

Y<z ounce, if no movement occurs in twelve 

hours, 566 
Cold, 313 

Enemas, to be tried first, in constipation, 566 
Glycerin and water, equal parts, with a little 

lemon juice, as a mouth-wash, if sores are 

present, 566 
Hydrochloric acid, dilute, gtt. 5, every few 

hours, or, if bowels are inactive, nitro- 

hydrochloric acid, gtt. 3, 566 
Lime-water added to milk, if vomiting threat- 
ens, 566 
Morphine if perforation occurs, 567 
Phosphorus if nervous system is affected, 248 
Prescription for diarrhoea, 566 
Qiiinine inferior to new antipyretics, 127 
Rest and diet, 564 

Silver nitrate highly recommended, 223 
Turpentine in the form of stupes, enemata, or 

by mouth, in tympanites, also useful in 

later stage, to relieve diarrhoea, heal ulcers, 

and prevent relapse, 289 



For remedies for complications, intestinal 
haemorrhage, pneumonia and pleurisy, see 
their titles 

ULCERS. 

Alcohol, a useful local application, 39 

Aristol, 65 

Benzoate of bismuth, as a dressing for indolent 

or sloughing ulcers, 77 
Burnt alum, as a dressing for old ulcers, 47 
Caustic potash, as an escharotic for exuberant 

ulcers, 110 
Chimaphila, said to be of service in strumous 

ulcers, 112 
Copper, in solid or powder form, locally ap- 
plied to indolent ulcers, 142 
Creolin, solution (1 to 100), as a douche for 

nasal ulcers, 143 
Gallic acid ointment, in actively discharging 

ulcers, 159 
Hamamelis, locally applied on a cloth, relieves 

leg ulcers, 167 
Hydrogen peroxide, a useful application, 240 
Lime, as an escharotic in slow ulcers, 92 
Nitric acid, as a caustic for phagedenic ulcers, 

or a solution (gtt. 5 to 30 to the ounce), 

locally applied to indolent types, 225 
Ointment of lead carbonate, as a dressing, 200 
Potassium permanganate (gr. 60 to the pint), as 

an antiseptic wash, 244 
Precipitated carbonate of calcium, as a dry 

dressing, 90 
Silver nitrate, in hard pills for intestinal ulcers 

and by injections for rectal and ceecal 

ulcers, 222 
Sulphuric acid, sometimes used as an escharotic 

in slow ulcers, 280 

URAEMIA. 

Elaterium, thought to aid elimination of poi- 
son by the bowel, 159 
Pilocarpine, the most efficient remedy, 194 

URIC ACID DIATHESIS. 

Acetate of potash, 34 

Lime-water, 92 

Prescription for prevention of formation of 

calculi, 81 

URTICARIA. 
Ichthyol ointment, highly recommended, 175 

UVULA, RELAXED. 
Capsicum, . tincture of, and glycerin, equal 

parts, as a gargle, 100 
Kino, as a gargle, 196 

VARICOCELE. 

Cold water, applied by bidet, highly recom- 
mended, 312 

VARICOSE VEINS. 

Barium chloride, internally and locally ap- 
plied, said to be of value, 73 

Hamamelis, useful internally or injected 
into part, 167 

VOMITING, 567 

Bismuth and aconite may be of service, pre- 
scription for, 569 



632 



INDEX OF DISEASES AND REMEDIES, 



Bromide of sodium or potassium with lauda- 
num, as a rectal injection in obstinate 
cases, prescription for, 85, 566 

Carbolic acid with bismuth, useful in acidity 
and fermentation, prescription for, 569 

Calomel, 213 

Chloroform, gtt. 1 to 2, in water, 569 

Cloves, oil of, sometimes controls, 132 

Cocaine or aconite, if due to hyper-excitability 
of stomach, 568 

Enemas, partially digested, if vomiting is in- 
coercible, 570 

Fowler's solution, gtt. % to 1, every two hours, 
useful in nausea following debauch, also 
in other cases instead of ipecac or nux 
vomica, 569 

Hydrocyanic acid, dilute, gtt. 2 to 6, in water, 
567 

Hydrochloric acid, in alcoholic nausea, 570 

Ice-bag, to nape of neck, lumbar region, or 
epigastrium, 570 

Ipecac, in small doses, it due to gastric depres- 
sion, 569 

Lime-water, added to milk, may relieve nausea, 
570 

Mustard plaster over stomach, useful in all 
cases, 570 

Nux vomica, if due to gastric depression, pre- 
scription for, 569 

Oxygen water, of great service, 240 

Peptonized milk, best food, 570 

Podophyllin, useful in some cases, 252 

Seidlitz powder, often settles stomach, if due 
to constipation, 267 

VOMITING OF PREGNANCY. 

Aconite, as a nervous sedative, 37 

Arsenic, may be tried, 68 

Bromide of potassium, as an effervescing 
draught, or with opium by enema, pre- 
scriptions for, 84, 85 

Cerium oxalate, gr. 2 to 5 in pill, every four or 
five hours, 111 

Cacaine, useful to decrease irritability, 134 

Iodine, tincture of, largely used of late with 
good results, 188 

Ipecac, wine, gtt. 1, or powder, gr. 2. useful in 
some cases, 191 

WARTS. 

Chromic acid (gr. 100 to the ounce), locally ap- 
plied, to remove, 124 
Fowler's solution, locally applied, 69 
Glacial acetic acid, useful to remove, 34 
Nitric acid, as a caustic, 225 

WHITE SWELLING. 

Iodine, 187 

WHOOPING-COUGH, 570 

Aconite or veratrum viride, if vascular engorge- 
ment is excessive, 571 

Amber, oil of, 48 

Amyl nitrite, when paroxysms interfere with 
respiration, 571 

Antipyrin, gr. y 2 to 3, every five hours, prob- 
ably the best remedy, 570 



Belladonna, tincture of, gtt. y 2 , thrice daily, to 
child of one or two years, 570 

Cannabis indica, sometimes of service, 97 

Chloral, 114 

Chloroform, a few whiffs if paroxysms inter- 
fere with respiration, 57 

Gelsemium, 161 

Hyoscyamus, probably better than belladonna, 
173 

Milk, in small amounts, may overcome vomit- 
ina following paroxysms, 571 

Monobromated camphor, 95 

Prescription for, 239 

Quinine (gr. 1 to the ounce), useful, also of ser- 
vice in exposed children as a prophvlactic, 
570 

Resorcin, gtt. 10 of a 2 per cent, solution, or, 
better, in spray, 254 

Silver nitrate (gr. % to 1 to the ounce), in spray, 
used when stomach is empty, 223 

WOUNDS. 

Collodion, as an air-tight dressing for small 

wounds. 138 
Potassium permanganate (gr. 60 to the pint), as 

an antiseptic wash, 244 
Sozoiodol, as an antiseptic and disinfectant in 

diseased wounds, 271 

WORMS, 591 

Aspidium, very efficient against tapeworm, 
prescription for, 158, 572 

Azedarach, as a remedy against round- worms, 
72 

Brayera, as an infusion, or fluid extract, 
against round-worms, 572 

Calomel, should follow or precede all drugs 
used for tapeworm, 572 

Castor oil, should follow remedies for round- 
worms, 572 

Chenopodium, oil of, gtt. 5 to 20, on sugar, to 
remove round-worms, 572 

Chloroform, should not be used against tape- 
worm, 123 

Kamala, drachms 1 to 2, in syrup, against tape- 
worm, 196 

Koosin, gr. 40 to adult, against round-worm ; 
contra-indicated in pregnant women, 572 

Pelletierine, gr. 20, in capsule, best remedy 
against tapeworm, 572 

Pepo, oz. 2, in confection, against tapeworm, 
572 

Quassia injections, preceded by soap and water, 
most useful remedy against seat- worms, 572 

Rue, should not be used against round-worms, 
257 

Rules for diet, preceding tseniacides, 571 

Salicylic acid, gr. 8, hourly, till 40 are taken, 
against round-worm, or as an injection 
against seat- worms, prescription for, 260 

Santonin, gr. 34 to %, for child, in troches, 
against round- worm, 572 

Spigelia, alone, or, better, with senna, to re- 
move round-worm, 571 

Turpentine and castor oil, equal parts, efficient 
but somewhat dangerous, against tape- 
worm, 289 



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of dentition; tables of weights and measures and comparative scales; instructions for ex- 
amining the urine ; list of disinfectants ; table of eruptive fevers ; lists of new remedie s 
and remedies not generally used ; incompatibles, poisons and antidotes ; artificial respira- 
tion ; table of doses, prepared to accord with the last revision of the U. S. Pharmacopoeia ; 
an extended table of Diseases and their remedies, and directions for ligation of ar- 
teries. 176 pages of blanks for all records of practice and erasable tablet. Handsomely 
bound in limp Morocco, with pocket, pencil, rubber and catheter scale. 

The Medical News Visiting List for 1890 is issued in three styles, as heretofore: 
Weekly (for 30 patients) ; Monthly, and Perpetual. Each in one volume, $1.25. Also 
furnished with Ready Reference Thumb-letter Index for quick use, 25 cents extra. For 
special offers, including Visiting List, see pages 1 and 2. 
This list is all that could be desired. It con- | list of diseases arranged alphabetically, giving 



tains a vast amount of useful information, especi- ! under each a list of the prominent drugs em- 

" doses ployed in the treatment. Wr. 
and therapeutics.— Canadian Practitioner. j Reference Thumb-letter Index is furnished. This 



ally for emergencies, and gives good table of doses ployed in the treatment. When ordered, a Ready 



It is a masterpiece. Some of the features are : is a feature peculiar to this Visiting List. — Physi- 
peculiar to "The Medical News Visiting List," j cian and Surgeon, December. 

notably the Therapeutic Table, prepared from Dr. ; For convenience and elegance it is not surpass- 
T. Lauder Brunton's book, which contains the , able. — Obstetric Gazette November. 



THE MEDICAL NEWS PHYSICIANS' LEDGEB. 

Containing 400 pages of fine linen " ledger "_ paper, ruled so that all the accounts of a 
large practice may be conveniently kept in it, either by single or double entry, for a long 
periocl. Strongly bound in leather, with cloth sides, and with a patent flexible back, 
which permits it to lie perfectly fiat when opened at any place. Price, $5.00. Also, 
a small special lot of same Ledger, with 300 pages. Price, $4.00. 



HABTSHOBNE, HENBY, A. M., M. !>., LL. D., 

Lately Professor of Hygiene in the University of Pennsylvania. 

A Conspectus of the Medical Sciences ; Containing Handbooks on Anatomy, 
Physiology, Chemistry, Materia Medica, Practice of Medicine, Surgery and Obstetrics. 
Second edition, thoroughly revised and greatly improved. In one large royal 12mo. 
volume of 1028 pages, with 477 illustrations. Cloth, $4.25 ; leather, $5.00. 

The object of this manual is to afford a conven- industry and energy of its able editor. — Boston 
lent work of reference to students during the brief Medical and Surgical Journal, Sept. 3, 1874. 
moments at their command while in attendance We can say with the strictest truth that it is the 
upon medical lectures. It is a favorable sign that best work of the kind with which we are ac- 
it has been found necessary, in a short space of quainted. It embodies in a condensed form all 
time, to issue a new and carefully revised edition, recent contributions to practical medicine, and is 
The illustrations are very numerous and unusu- j therefore useful to every Dusy practitioner through- 
ally clear, and each part seems to have received out our country, besides being admirably adapted 
its due share of attention. We can conceive such to the use of students of medicine. The book is 
a work to be useful, not only to students, but to! faithfully and ably executed.— Charleston Medical 
practitioners as well. It reflects credit upon the j Journal, April, 1875. 



NEILL 9 JOHN, M. D., and SMITH, F. G., M. D., 

Late Surgeon to the Penna. Hospital. Prof, of the Institutes of Med. in the Univ. of Penna. 

An Analytical Compendium of the Various Branches of Medical 
Science, for the use and examination of Students. A new edition, revised and improved. 
In one large royal 12mo. volume of 974 pages, with 374 woodcuts. Cloth, $4 ; leather, $4.75. 



LUDLOW, J. L., M. D., 

Consulting Physician to the Philadelphia Hospital, etc. 

A Manual of Examinations upon Anatomy, Physiology, Surgery, Practice o f 
Medicine, Obstetrics, Materia Medica, Chemistry, Pharmacy and Therapeutics. To which 
is added a Medical Formulary. Third edition, thoroughly revised, and greatly enlarged. In 
one 12mo. volume of 816 pages, with 370 illustrations. Cloth, $3.25 ; leather, $3.75. 

The arrangement of this volume in the form of question and answer renders it espe- 
cially suitable for the office examination of students, and for those preparing for graduation. 



HOBLYN, BICHABD D., M. D. 

A Dictionary of the Terms Used in Medicine and the Collateral 
Sciences. Kevised, with numerous additions, by Isaac Hays, M. D., late editor of 
The American Journal of the Medical Sciences. In one large royal 12mo. volume of 520 
double-columned pages. Cloth, $1.50 ; leather, $2.00. 

It is the best book of definitions we have, and ought always to be upon the student's table.— Southern 
Medical and Surgical Journal. 



Lea Brothers & Co.'s Publications — Dictionaries. 



JUST READY. 



the; 



Datiodal IHgdigal Di^TionwY 



NCLUDING 



English, French, German, Italian and Latin Technical Terms used in Medicine and 
the Collateral Sciences, and a Series of Tables of Useful Data. 



BY 



John $, Billings, I].D, LLD, Ediq. and Hai'V., D.d.L, O^oq. 

Member of the National Academy of Sciences, Surgeon U. S. A., etc. 
WITH THE COLLABORATION OF 



Prof. W. O. ATWATER, JAMES M. FLINT, M. D., 

FRANK BAKER, M. D., J. H. KIDDER, M. D., 

S. M. BURNETT, M. D., WILLIAM LEE, M. D., 

W. T. COUNCILMAN, M. D., R. LORINI, M.D., 



WASHINGTON MATTHEWS, M. D., 
C. S. MINOT, M.D. 
H. C. YARROW, M. D., 



In two very handsome royal octavo volumes containing 1574 pages, 
with two colored plates. 

Per Volume— Cloth, $6; Leather, $7 ; Half Morocco, Marbled Edges, $8.50. For Sale 
by Subscription only. Specimen pages on application. Address the Publishers. 



The publishers have great pleasure in presenting to the profession a new practical 
working dictionary embracing in one alphabet all current terms used in every depart- 
ment of medicine in the five great languages constituting modern medical literature. 

For the vast and complex labor involved in such an undertaking no one better quali- 
fied than Dr. Billings could have been selected. He has planned the work, chosen the 
most accomplished men to assist him in special departments, and personally supervised 
and combined their work into a consistent and uniform whole. 

Special care has been taken to render the definitions clear, sharp and concise. 
Pronunciation has been indicated by a simple phonetic spelling and by accents wherever 
necessary. The definitions are given in English, with synonyms in French, German 
and Italian of the more important words in English and Latin. 

Eegarded as a dictionary, therefore, this coming standard supplies the physician, 
surgeon and specialist with all information concerning medical words, simple and com- 
pound, found in English, giving correct spelling, clear, sharp definitions and proper 
pronunciation, and furthermore it enables him to consult foreign works and to understand 
the large and increasing number of foreign words used in medical English. It is especi- 
ally full in phrases comprising two, three or more words used in special senses in the 
various departments of medicine. 

The work is, however, far more than a dictionary, and partakes of the nature of an 
encyclopaedia, as it gives in its body a large amount of valuable therapeutical and chemi- 
cal information, and groups in its tables, in a condensed and convenient form, a vast 
amount of important data which will be consulted daily by all in active practice. 

The completeness of the work is made evident by the fact that it defines 84,844 
separate words and phrases. 

The type has been most carefully selected for boldness and clearness, and everything 
has been done to secure ease and rapidity in use. 



• Its scope is one which will at once satisfy the 
student and meet all the requirements of the med- 
ical practitioner. Clear and comprehensive defi- 
nitions of words should form the prime feature of 
any dictionary, and in this one the chief aim 
seems to be to give the exact signification and the 
different meanings of terms in use in medicine 
and the collateral sciences in language as terse as 
is compatible with lucidity. The utmost brevity 
and conciseness have been kept in view. The work 
is remarkable, too, for its fulness. The enumera- 
tions and subdivisions under each word heading 
are strikingly complete, as regards alike the Eng- 
lish tongue and the languages chiefly employed 
by ancient and modern science. It is impossible 
to do justice to the dictionary by any casual illus 
t ration. It presents to the English reader a 
t horoughly scientific mode of acquiring a rich 
vocabulary and offers an accurate and ready means 
of reference in consulting works in any of the 



three modern continental languages which are 
richest in medical literature. To add to its use- 
fulness as a work of reference some valuable 
tables are given. Another feature of the work is 
the accuracy of its definitions, all of which have 
been checked by comparison with many other 
standard works in the different languages it deals 
with. Apart from the boundless stores of informa- 
tion which may be gained by the study of a good 
dictionary, one is enabled by the work under notice 
to read intelligently any technical treatise in any 
of the four chief modern languages. There can- 
not be two opinions as to the great value and use- 
fulness of this dictionary as a book of ready refer- 
ence for all sorts and conditions of medical men. 
So far as we have been able to see, no subject has 
been omitted, and in respect of completeness it will 
be found distinctly superior to any medical lexicon 
yet published.— The London Lancet, April 5, 1890. 



Lea Brothers & Co.'s Publications — Anatomy. 5 

GHAT, FLFNKY, F. It. S., 

Lecturer on Anatomy at St. George's Hospital, London. 

Anatomy, Descriptive and Surgical. Edited by T. Pickering Pick, 
F. R. C, S., Surgeon to and Lecturer on Anatomy at St. George's Hospital, London, 
Examiner in Anatomy, Royal College of Surgeons of England. A new American from 
the eleventh enlarged and improved London edition, thoroughly revised and re-edited 
by William W. Keen, M. D., Professor of Surgery in the Jefferson Medical College of 
Philadelphia. To which is added the second American from the latest English edition of 
Landmarks, Medical and Surgical, by Luther Holden, F. R. C. S. In one imperial 
octavo volume of 1098 pages, with 685 large and elaborate engravings on wood. Price of 
edition in black : Cloth, $6 ; leather, $7 ; half Russia, $7.50. Price of edition in colors 
(see below) . Cloth, $7.25; leather, $8.25; half Russia, $8.75.^ 

This work covers a more extended range of subjects than is customary in the ordinary 
text-books, giving not only the details necessary for the student, but also the application to 
those details to the practice of medicine and surgery. It thus forms both a guide for the 
learner and an admirable work of reference for the active practitioner. The engravings 
form a special feature in the work, many of them being the size of nature, nearly all 
original, and having the names of the various parts printed on the body of the cut, in 
place of figures of reference with descriptions at the foot. In this edition a new departure 
has been taken by the issue of the work with the arteries, veins and nerves distinguished 
by different colors. The engravings thus form a complete and splendid series, which will 
greatly assist the student in forming a clear idea of Anatomy, and will also serve to refresh 
the memory of those who may find in the exigencies of practice the necessity of recall- 
ing the details of the dissecting-room. Combining, as it does, a complete Atlas of 
Anatomy with a thorough treatise on systematic, descriptive and applied Anatomy, 
the work will be found of great service to all physicians who receive students in their 
offices, relieving both preceptor and pupil of much labor in laying the groundwork of a 
thorough medical education. 

For the convenience of those who prefer not to pay the slight increase in cost necessi- 
tated by the use of colors, the volume is published also in black alone, and maintained 
in this style at the price of former editions, notwithstanding its largely increased size. 

Landmarks, Medical and Surgical, by the distinguished Anatomist, Mr. Luther Holden, 
has been appended to the present edition as it was to the previous one. This work gives 
in a clear, condensed and systematic way all the information by which the practitioner can 
determine from the external surface of the body the position of internal parts. Thus 
complete, the work will furnish all the assistance that can be rendered by type and 
illustration in anatomical study. 

The most popular work on anatomy ever written, books. The work is published with black and 
It is sufficient to say of it that this edition, thanks colored plates. It is a marvel of book-making. — 
to its American editor, surpasses all other edi- American Practitioner and News, Jan. 21, 1888. 
tions. — Jour, of the Amer. Med. Ass'n, Dec. 31, 1887. Gray's Anatomy is the most magnificent work 

A work which for more than twenty years has upon anatomy which has ever been published in 
had the lead of all other text-books on anatomy the English or any other language.— Cincinnati 
throughout the civilized world comes to hand in Medical News, Nov. 1887. 

such beauty of execution and accuracy of text As the book now goes to the purchaser he is re- 
and illustration as more than to make good the ; ceiving the best work on anatomy that is published 
large promise of the prospectus. It would be in- <■ in any language.— Virginia Med. Monthly, Dec. 1887. 
deed difficult to name a feature wherein the pres- ! Gray's standard Anatomy has been and will be 
ent American edition of Gray could be mended : for years the text-book for students. The book 



or bettered, and it needs no prophet to see that I needs only to be ^examined to be perfectly under- 
J royal work is destined for many years to come 
hold the first place among anatomical text- 



the royal work is destined for many years to come j stood. — Medical Press of Western New York, Jan. 
to hold 



Also for sale separate — 
HOLDER, LUTHFB, F. K. C. S., 

Surgeon to St. Bartholomew's and the Foundling Hospitals, London. 

Landmarks, Medical and Surgical. Second American from the latest revised 
English edition, with additions by W. W. Keen, M. D., Professor of Artistic Anatomy in 
the Penn. Academy of Fine Arts. In one 12mo. volume of 148 pages. Cloth, $1.00 



DTJNGLISOl?, ROBLFY, M.D., 

Late Professor of Institutes of Medicine in the Jefferson Medical College of Philadelphia. 

MEDICAL LEXICON ; A Dictionary of Medical Science : Containing 
a concise Explanation of the various Subjects and Terms of Anatomy, Physiology, Pathol- 
ogy, Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics, Medical Juris- 
prudence and Dentistry, Notices of Climate and of Mineral Waters, Formulae for Officinal, 
Empirical and Dietetic Preparations, with the Accentuation and Etymology of the Terms, 
and the French and other Synonymes, so as to constitute a French as well as an English 
Medical Lexicon. Edited by Richard J. Dunglison, M. D. In one very large and 
handsome royal octavo volume of 1139 pages. Cloth, $6.50; leather, raised bands, $7.50; 
very handsome half Russia, raised bands, $8. 

It has the rare merit that it certainly has no rival in the English language for accuracy 
■and extent of references.— London Medical Gazette. 



Lea Brothers & Co.'s Publications — Anatomy. 



ALLEN, HARRISON, M. D., 

Professor of Physiology in the University of Pennsylvania. 

A System of Human Anatomy, Including Its Medical and Surgical 
Relations. For the use of Practitioners and Students of Medicine. With an Intro- 
ductory Section on Histology. By E. O. Shakespeare, M. D., Ophthalmologist to 
the Philadelphia Hospital. Comprising 813 double-columned quarto pages, with 380 
illustrations on 109 full page lithographic plates, many of which are in colors, and 241 
engravings in the text. In six Sections, each in a portfolio. Section I. Histology. 
Section II. Bones and Joints. Section III. Muscles and Fasciae. Section IV. 
Arteries, Veins and Lymphatics. Section V. Nervous System. Section VI. 
Organs of Sense, of Digestion and Genito-Urinary Organs, Embryology, 
Development, Teratology, Superficial Anatomy, Post-Mortem Examinations, 
and General and Clinical Indexes. Price per Section, $3.50 ; also bound in one 
volume, cloth, $23.00 ; very handsome half Kussia, raised bands and open back, $25.00. 
For sale by subscription only. Apply to the Publishers. 



It is to oe considered a study of applied anatomy 
In its widest sense — a systematic presentation of 
such anatomical facts as can be applied to the 
practice of medicine as well as of surgery. Our 
author is concise, accurate and practical in his 
statements, and succeeds admirably in infusing 
an interest into the study of what is generally con- 
sidered a dry subject. The department of Histol- 
ogy is treated in a masterly manner, and the 
ground is travelled over by one thoroughly famil- 
iar with it. The illustrations are made witn great 



care, and are simply superb. There is as much 
of practical application of anatomical points to 
the every-day wants of the medical clinician as 
to those of the operating surgeon. In fact, few 
general practitioners will read the work without a 
feeling of surprised gratification that so many 
points, concerning which they may never have 
thought before are so well presented for their con- 
sideration. It is a work which is destined to be 
the best of its kind in any language. — Medical 
Record, Nov. 25, 1882. 



CLARKE 9 W. B.,F.R.C.S. & LOCKWOOD,€.B.,F.R.C.S. 

Demonstrators of Anatomy at St. Bartholomew" 's Hospital Medical School, London. 
The Dissector's Manual. In one pocket-size 12mo. volume of 396 pages, with 
49 illustrations. Limp cloth, red edges, $1.50. See Students' Series of Manuals, page 31. 

Messrs. Clarke and Lockwood have written a book I intimate association with students could have 
that can hardly be rivalled as a practical aid to the I given. With such a guide as this, accompanied 
dissector. Their purpose, which is " how to de- by so attractive a commentary as Treves' Surgical 



scribe the best way to display the anatomical 
structure," has been fully attained. They excel in 
a lucidity of demonstration and graphic terseness 
of expression, which only a long training and 



Applied Anatomy (same series), no student could 
fail to be deeply and absorbingly interested in the 
study of anatomy. — New Orleans Medical and Sur- 
gical Journal, April, 1884. 



TREVES, FREDERICK, E. R. C. S. 9 

Senior Demonstrator of Anatomy and Assistant Surgeon at the London Hospital. 

Surgical Applied Anatomy. In one pocket-size 12mo. volume of 540 pages, 
with 61 illustrations. Limp cloth, red edges, $2.00. See Students' Series of Manuals^ 
page 31. 



He has produced a work which will command a 
larger circle of readers than the class for which it 
was written. This union of a thorough, practical 
acquaintance with these fundamental branches, 
quickened by daily use as a teacher and practi- 
tioner, has enabled our author to prepare a work 
which it would be a most difficult task to excel.— 
The American Practitioner, Feb. 1884. 



This number of the "Manuals for Students" is 
most excellent, giving just such practical knowl- 
edge as will be required for application in relieving 
the injuries to which the living body is liable. 
The book is intended mainly for students, but it 
will also be of great use to practitioners. The illus- 
trations are well executed and fully elucidate the 
text.— Southern Practitioner, Feb. 1884. 



BELLAMY, EDWARD, E. R. C. S., 

Senior Assistant-Surgeon to the Charing-Cross Hospital, London. 

The Student's Guide to Surgical Anatomy : Being a Description of the 
most Important Surgical Eegions of the Human Body, and intended as an Introduction to 
operative Surgery. In one 12mo. volume of 300 pages, with 50 illustrations. Cloth, $2.25. 

WILSON, ERASMUS, F. R. S. 

A System of Human Anatomy, General and Special. Edited by W. H. 
Gobrecht, M. D., Professor of General and Surgical Anatomy in the Medical College of 
Ohio. In one large and handsome octavo volume of 616 pages, with 397 illustrations. 
Cloth, $4.00; leather, $5.00. 

CLELAND, JOHN, M. D., F. R. S., 

Professor of Anatomy and Physiology in Queen's College, Galway. 

A Directory for the Dissection of the Human Body. In one 12mo. 

volume of 178 pages. Cloth, $1.25. 



HARTSHORNE'S HANDBOOK OF ANATOMY 
AND PHYSIOLOGY. Second edition, revised. 
In one royal 12mo. volume of 310 pages, with 220 
woodcuts. Cloth, $1.75. 



HORNER'S SPECIAL ANATOMY AND HISTOL- 
OGY. Eighth edition, extensively revised and 
modified. In two octavo volumes of 1007 pages, 
with 320 woodcuts. Cloth, $6.00. 



Lea Brothers & Co. s Publications — Physics, Physiol., Anat. 7 
DRAPER, JOHN C M. I)., LL. I)., 

Professor of Chemistry in the University of the City of New York. 
Medical Physics. A Text-book for Students and Practitioners of Medicine. In 
one octavo volume of 734 pages, with 376 woodcuts, mostly original. Cloth, $4. 

FROM THE PREFACE. 

The fact that a knowledge of Physics is indispensable to a thorough understanding of 
Medicine has not been as fully realized in this country as in Europe, where the admirable 
works of Desplats and Gariel, of Robertson and of numerous German writers constitute a 
branch of educational literature to which we can show no parallel. A full appreciation 
of this the author trusts will be sufficient justification for placing in book form the sub- 
stance of his lectures on this department of science, delivered during many years at the 
University of the City of New York. 

Broadly speaking, this work aims to impart a knowledge of the relations existing 
between Physics and Medicine in their latest state of development, and to embody in the 
pursuit of this object whatever experience the author has gained during a long period of 
teaching this special branch of applied science. 

This elegant and useful work bears ample testi- I explained, acoustics, optics, heat, electricity and 
mony to the learning and good judgment of the magnetism, closing with a section on electro- 
author. He has fitted his work admirably to the biology. The applications of all these to physiology 
exigencies of the situation by presenting the i and medicine are kept constantly in view. The 
reader with brief, clear and simple statements of \ text is amply illustrated and the many difficult 
such propositions as he is by necessity required to j points of the subject are brought forward with re- 
master. The subject matter is well arranged, j markable clearness and ability. — Medical and Surg- 
liberally illustrated and carefully indexed. That I ical Reporter, July 18, 1885. 

it will take rank at once among the text-books is : That this work will greatly facilitate the study 
certain, and it is to be hoped that it will find a j of medical physics is apparent upon even a mere 
place upon the shelf of the practical physician, cursory examination. It is marked by that scien- 
where, as a book of reference, it will be found | tific accuracy which always characterizes Dr. 



useful and agreeable. — Louisville Medical News, 
Septemoer 26, 1S85. 

Certainly we have no text-book as full as the ex- 
cellent one he has prepared. It begins with a 
statement of the properties of matter and energy. 
After these the special departments of physics are 



Draper's writings. Its peculiar value lies in the 
fact that it is written from the standpoint of the 
medical man. Hence much is omitted that ap- 
pears in a mere treatise on physical science, while 
much is inserted of peculiar value to the physi- 
cian. — Medical Record, August 22, 1885. 



Robertson j. McGregor, m. a., m. b., 

Muirhead Demonstrator of Physiology, University of Glasgow. 
Physiological Physics. In one 12mo. volume of 537 pages, with 219 illustra- 
tions. Limp cloth, $2.00. See Students' Series of Manuals, page 31. 

The title of this work sufficiently explains the | ments. It will be found of great value to the 
nature of its contents. It is designed as a man- j practitioner. It is a carefully prepared book of 
ual for the student of medicine, an auxiliary to ' reference, concise and accurate, and as such we 
his text-book in physiology, and it would be particu- i heartily recommend it. — Journal of the American 
larly useful as a guide to his laboratory experi- j Medical Association, Dec. 6, 1884. 

DALTOW, JOHJST C, M. L>~ 

Professor Emeritus of Physiology in the College of Physicians and Surgeons, New York. 

Doctrines of the Circulation of the Blood. A History of Physiological 
Opinion and Discovery in regard to the Circulation of the Blood. In one handsome 
12mo. volume of 293 pages. Cloth, $2. 

Dr. Dalton's work is the fruit of the deep research ! revolutionized the theories of teachers, than the 
of a cultured mind, and to the busy practitioner it ; discovery of the circulation of the blood. This 
cannot fail to be a source of instruction. It will i explains the extraordinary interest it has to all 
inspire him with a feeling of gratitude and admir-i medical historians. The volume before us is one 
ation for those plodding workers of olden times, of three or four which have been written within a 
who laid the foundation of the magnificent temple ; few years by American physicians. It is in several 
of medical science as it now stands. — New Orleans I respects the most complete. The volume, though 
Medical and Surgical Journal, Aug. 1885. j small in size, is one of the most creditable oon- 

In the progress of physiological study no fact , tributions from an American pen to medical history 
was of greater moment, none more completely > that has appeared. — Med. & Surg. Rep., Dec. 6, 1884. 

BELL, F. JEFFREY, M. A., 

Professor of Comparative Anatomy at King's College, London. 

Comparative Physiology and Anatomy. In one 12mo. volume of 561 pages, 
with 229 illustrations. Limp cloth, $2.00. See Students 1 Series of Manuals, page 31. 

The manual is preeminently a student's book— j it the best work in existence in the English 
clear and simple in language and arrangement. | language to place in the hands of the medical 
It is well and abundantly illustrated, and is read- ! student.— Bristol Medico- Chirurgical Journal, Mar. 
able and interesting. On the whole we consider | 1886. 



ELLIS, GEORGE VUSTER, 

Emeritus Professor of Anatomy in University College, London. 

Demonstrations of Anatomy. Being a Guide to the Knowledge of the 
Human Body by Dissection. From the eighth and revised London edition. In one very 
handsome octavo volume of 716 pages, with 249 illustrations. Cloth, $4.25 ; leather, $5.25. 

ROBERTS, JOHJST B., A. M., M. L>., 

Prof, of Applied Anat. and Oper. Surg, in Phila. Polyclinic and Coll. or Graduates in Medicine. 
The Compend of Anatomy. For use in the dissecting-room and in preparing 
for examinations. In one 16mo. volume of 196 pages. Limp cloth, 75 cents. 



8 Lea Brothers & Co.'s Publications — Physiology, Chemistry. 



CHAPMAN, HENBY C, M. !>., 

Professor of Institutes of Medicine and Medical Juris, in the Jefferson Med. Coll. of Philadelphia. 

A Treatise on Human Physiology. In one handsome octavo volume of 
925 pages, with 605 fine engravings. Cloth, $5.50 ; leather, $6.50. 

farther, and the latter will rind entertainment and 



It represents very fully the existing state of 
physiology. The present work has a special value 
to the student and practitioner as devoted more 
to the practical application of well-known truths 
which the advance of science has given to the 
profession in this department, which may be con- 
sidered the foundation of rational medicine. — Buf- 
falo Medical and Surgical Journal, Dec. 1887. 

Matters which have a practical bearing on the 
practice of medicine are lucidly expressed; tech- 
nical matters are given in minute detail; elabo- 
rate directions are stated for the guidance of stu- 
dents in the laboratory. In every respect the 
work fulfils its promise, whether as a complete 
treatise for the student or for the physician ; for 
the former it is so complete that he need look no 



instruction in an admirable book of reference. — 
North Carolina Medical Journal, Nov. 1887. 

The work certainly commends itself to both 
student and practitioner. What is most demanded 
by the progressive physician of to-day is an adap- 
tation of physiology to practical therapeutics, and 
this work is a decided improvement in this respect 
over other works in the market. It will certainly 
take place among the most valuable text-books. — 
Medical Age, Nov. 25, 1887. 

It is the production of an author delighted with 
his work, and able to inspire students with an en- 
thusiasm akin to his own. — American Practitioner 
and News, Nov. 12, 1887. 



DALTON, JOHN a, M. D., 

Professor of Physiology in the College of Physicians and Surgeons, New York, etc. 
A Treatise on Human Physiology. Designed for the use of Students and 
Practitioners of Medicine. Seventh edition, thoroughly revised and rewritten. In one 
very handsome octavo volume of 722 pages, with 252 beautiful engravings on wood. Cloth, 
$5.00; leather, $6.00. 



From the first appearance of the book it has 
been a favorite, owing as well to the author's 
renown as an oral teacher as to the charm of 
simplicity with which, as a writer, he always 
succeeds in investing even intricate subjects. 
It must be gratifying to him to observe the fre- 
quency with which his work, written for students 
and practitioners, is quoted by other writers on 
physiology. This fact attests its value, and, in 
great measure, its originality. It now needs no 
such seal of approbation, however, for the thou- 
sands who have studied it in its various editions 



have never been in any doubt as to its sterling 
worth.— N. Y. Medical Journal, Oct. 1882. 

Professor Dalton's well-known and deservedly- 
appreciated work has long passed the stage at 
which it could be reviewed in the ordinary sense. 
The work is eminently one for the medical prac- 
titioner, since it treats most fully of those branches 
of physiology which have a direct bearing on the 
diagnosis and treatment of disease. The work is 
one which we can highly recommend to all our 
readers. — Dublin Journal of Medical Science, Feb.'83. 



FOSTEB, MICHAEL, M. D., F. B. S., 

Prelector in Physiology and Fellow of Trinity College, Cambridge, England. 
Text-Book of Physiology. New (fourth) and enlarged American from the 
fifth and revised English edition, with notes and additions. Preparing. 

A REVIEW OF THE FIFTH ENGLISH EDITION IS APPENDED. 

tions, and his energies are not frittered away and 
degenerated on petty and trivial details. Review- 



It is delightful to meet a book which deserves 
only unqualified praise. Such a book is now before 
us. It is in all respects an ideal text-book. With a 
complete, accurate and detailed knowledge of his 
subject, the author has succeeded in giving a 
thoroughly consecutive and philosophic account 
of the science. A student's attention is kept 
throughout fixed on the great and salient ques- 



ing this volume as a whole we are justified in say- 
ing that it is the only thoroughly good text-book 
of physiology in the English language, and that it 
is probably the best text-book in any language. 
— Edinburgh Medical Journal, December 1889. 



POWEB, HENRY, M. B., F. B. C. S., 

Examiner in Physiology, Royal College of Surgeons of England. 
Human Physiology. Second edition. In one handsome pocket-size 12mo. vol- 
ume of 396 pp., with 47 illustrations. Cloth, $1.50. See Students' Series of Manuals, p. 31. 

SIMON, W., JPh. JD., M. JO., 

Professor of Chemistry and Toxicology in the College of Physicians and Surgeons, Baltimore, and 
Professor of Chemistry in the Maryland College of Pharmacy. 

Manual Of Chemistry. A Guide to Lectures and Laboratory work for Beginners 
in Chemistry. A Text-book, specially adapted for Students of Pharmacy and Medicine. 
New (second) edition. In one 8vo. vol. of 478 pp., with 44 woodcuts and 7 colored plates 
illustrating 56 of the most important chemical tests. Cloth, $3.25. 

In this book the author has endeavored to meet 
the wants of the student of medicine or pharmacy 
in regard to his chemical studies, and he has suc- 
ceeded in presenting his subject so clearly that no 
one who really wishes to acquire a fair knowledge 
of chemistry can fail to do so with the help of this 
work. The largest section of the book is naturally 
that devoted to the consideration of the carbon 
compounds, or organic chemistry. An excellent 



feature is the introduction of a number of plates 
showing the various colors of the most important 
chemical reactions of the metallic salts, of some 
of the alkaloids, and of. the urinary tests. In the 
part treating of physiological chemistry the section 
on analysis of the urine will be found very practi- 
cal, and well suited to the needs of the practitioner 
of medicine.— The Medical Record, May 25, 1889. 



"Wohler's Outlines of Organic Chemistry. Edited by Fittig. Translated 
by Ira Eemsen, M. D., Ph. D. In one 12mo. volume of 550 pages. Cloth, $3. 



LEHMANN'S MANUAL OF CHEMICAL PHYS- 
IOLOGY. In one octavo volume of 327 pages, 
with 41 illustrations. Cloth, $2.25. 

CARPENTER'S HUMAN PHYSIOLOGY. Edited 
by Henry Power. In one octavo volume. 



CARPENTER'S PRIZE ESSAY ON THE USE AND 
Abuse of Alcoholic Liquors in Health and Dis- 
ease. With explanations of scientific words. Small 
12mo. 178 pages. Cloth, 60 cents. 



Lea Brothers & Co.'s Publications — Chemistry. 



9 



FRANKLANJD, E., JD. C. L., F. U.S., &JAFF, F. R., F. I. C, 



Professor of Chemistry in the Normal School 
of Science, London. 



Assist. Prof, of Chemistry in the Normal 
School of Science, London. 



Inorganic Chemistry. In one handsome octavo volume of 677 pages with 51 
woodcuts and 2 plates. Cloth, $3.75 ; leather, $4.75. 

This work should supersede other works of its 
class in the medical colleges. It is certainly better 
adapted than any work upon chemistry,with which 
we are acquainted, to impart that clear and full 
knowledge of the science which students of med- 
icine should have. Physicians who feel that their 
chemical knowledge is behind the times, would 
do well to devote some of their leisure time to the 
study of this work. The descriptions and demon- 
strations are made so plain that there is no diffi- 
culty in understanding them.— Cincinnati Medical 
News, January, 1886. 



This excellent treatise will not fail to take its 
place as one of the very best on the subject of 
which it treats. We have been much pleased 
with the comprehensive and lucid manner in 
which the difficulties of chemical notation and 
nomenclature have been cleared up by the writers. 
It shows on every page that the problem of 
rendering the obscurities of this science easy 
of comprehension has long and successfully 
engaged the attention of the authors. — Medical 
and Surgical Reporter, October 31, 1885. 



FOWJTES, GEORGE, Fh. JD. 

A Manual of Elementary Chemistry; Theoretical and Practical. Em- 
bodying Watts' Physical Inorganic Chemistry. New American, from the twelfth English 
edition. In one large royal 12mo. volume of 1061 pages, with 168 illustrations on wood 
and a colored plate. Cloth, $2.75 ; leather, $3.25. 
Fownes* CJiemistry has been a standard text- \ chemistry extant. — Cincinnati Medical News, Oc- 



book upon chemistry for many years. Its merits 
are very fully known by chemists and physicians 
everywhere in this country and in England. As 
the science has advanced by the making of new 
discoveries, the work has been revised so as to 
keep it abreast of the times. It has steadily 
maintained its position as a textbook with medi- 
cal students. In this work are treated fully : Heat, 
Light and Electricity, including Magnetism. The 
influence exerted by these forces in chemical 
action upon health and disease, etc., is of the most 
important kind, and should be familiar to every 
medical practitioner. We can commend the 
work as one of the very best text-books upon 



tober, 1885. 

Of all the works on chemistry intended for the 
use of medical students, Fownes' Chemistry is 
perhaps the most widely used. Its popularity is 
based upon its excellence. This last edition con- 
tains all of the material found in the previous, 
and it is also enriched by the addition of Watts 5 
Physical and Inorganic Chemistry. All of the mat- 
ter is brought to the present standpoint of chemi- 
cal knowledge. We may safely predict for this 
work a continuance of the fame and favor it enjoys 
among medical students.— New Orleans Medical 
and Surgical Journal, March, 1886. 



ATTFIELJD, JOHN, Fh. D., 

Professor of Practical Chemistry to the Pharmaceutical Society of Ghreat Britain, etc. 

Chemistry, General, Medical and Pharmaceutical; Including the Chem- 
istry of the U. S. Pharmacopoeia. A Manual of the General Principles of the Science, 
and their Application to Medicine and Pharmacy. A new American, from the twelfth 
English edition, specially revised by the Author for America. In one handsome royal 
12mo. volume of 782 pages, with 88 illustrations. Cloth, $2.75 ; leather, $3.25. Just ready. 

again it is a good laboratory guide, and finally it 



Attfield's Chemistry is the most popular book 
among students of medicine and phai macy. This 
popularity has a good, substantial basis. It rests 
upon real merits. Attfield's work combines in the 
happiest manner a clear exposition of the theory 
of chemistry with the practical application of this 
knowledge to the everyday dealings of the phy- 
sician and pharmacist. His discernment is shown 
not only in what he puts into his work, but also in 
what he leaves out. His book is precisely what 
the title claims for it. The admirable arrangement 
of the text enables a reader to get a good idea of 
chemistry without the aid of experiments, and 



contains such a mass of well-arranged information 
that it will always serve as a handy book of refer- 
ence. He does not allow any unutilizable knowl- 
edge to slip into his book; his long years of 
experience have produced a work which is both 
scientific and practical, and which shuts out 
everything in the nature of a superfluity, and 
therein lies the secret of its success. This last 
edition shows the marks of the latest progress 
made in chemistry and chemical teaching.— New 
Orleans Medical and Surgical Journal, Nov. 1889. 



BLOXAM, CHARLES L., 

Professor of Chemistry in King's College, London. 

Chemistry, Inorganic and Organic. New American from the fifth Lon- 
don edition, thoroughly revised and much improved. In one very handsome octavo 
volume of 727 pages, with 292 illustrations. Cloth, $2.00 ; leather, $3.00. 



Comment from us on this standard work is al- 
most superfluous. It differs widely in scope and 
aim from that of Attfield, and in its way is equally 
beyor.d criticism. It adopts the most direct meth- 
ods in stating the principles, hypotheses and facts 
of the science. Its language is so terse and lucid, 
and its arrangement of matter so logical in se- 
quence that the student never has occasion to 
complain that chemistry is a hard study. Much 
attention is paid to experimental illustrations oi 
chemical principles and phenomena, and the 
mode of conducting these experiments. The book 
maintains the position it has always held as one of 



the best manuals of general chemistry in the Eng- 
lish language. — Detroit Lancet, Feb. 1884. 

We know of no treatise on chemistry which 
contains so much practical information in the 
same number of pages. The book can be readily 
adapted not only to the needs of those who desire 
a tolerably complete course of chemistry, but also 
to the needs of those who desire only a general 
knowledge of the subject. We take pleasure in 
recommending this work both as a satisfactory 
text- book, and as a useful book of reference. — Bos- 
ton Medical and Surgical Journal, June 19, 1884. 



GREENE, WILLIAM Ft, M. D., 

Demonstrator of Chemistry in the Medical Department of the University of Pennsylvania. 

A Manual of Medical Chemistry. For the use of Students. Based upon Bow* 
man's Medical Chemistry. In one 12mo. volume of 310 pages, with 74 illus. Cloth, $1.75. 
It is a concise manual of three hundred pages, | the recognition of compounds due to pathological 
giving an excellent summary of the best methods I conditions. The detection of poisons is treated 
of analyzing the liquids and solids of the body, both with sufficient fulness for the purpose of thestu- 
for the estimation of their normal constituent and | dent or practitioner. — Boston Jl. of Chem. June,'80. 



10 



Lea Brothers & Co.'s Publications — Chemistry. 



REMSEN, IRA, M. D., Ph. D., 

Professor of Chemistry in the Johns Hopkins University, Baltimore' 

Principles of Theoretical Chemistry, with special reference to the Constitu- 
tion of Chemical Compounds. New (third) and thoroughly revised edition. In one hand- 
some royal 12mo. volume of 316 pages. Cloth, $2.00 

This work of Dr. Remsen is the very text-book j examination of college faculties as the text-book of 
needed, and the medical student who has it at i chemical instruction.— St. Louis Medical and Sur- 



his fingers' ends, so to speak, can, if he chooses, 
make himself familiar with any branch of chem- 
istry which he may desire to pursue. It would be 
difficult indeed to find a more lucid, full, and at 
the same time compact explication of the philos- 
ophy of chemistry, than the book before us, and 
we recommend it to the careful and impartial 



gical Journal, January, 1888. 

It is a healthful sign when we see a demand for 
a third edition of such a book as this. This edi- 
tion is larger than the last by about seventy-five 
pages, and much of it has been rewritten, thus 
bringing it fully abreast of the latest investiga- 
tions. — N. Y. Medical Journal, Dec. 31, 1887. 



CHARLES, T. CRANSTOUN, M. D., F. C. S., M. S., 

Formerly Asst. Prof, and Demonst. of Chemistry and Chemical Physics, Queen's College, Belfast. 

The Elements of Physiological and Pathological Chemistry. A 

Handbook for Medical Students and Practitioners. Containing a general account of 
Nutrition, Foods and Digestion, and the Chemistry of the Tissues, Organs, Secretions and 
Excretions of the Body in Health and in Disease. Together with the methods for pre- 
paring or separating their chief constituents, as also for their examination in detail, and 
an outline syllabus of a practical course of instruction for students. In one handsome octavo 
volume of 463 pages, with 38 woodcuts and 1 colored plate. Cloth, $3.50. 

nowadays. Dr. Charles has devoted much space 
to the elucidation of urinary mysteries. He does 
this with much detail, and yet in a practical and 
intelligible manner. In fact, the author has filled 
his book with many practical hints. — Medical Rec- 
ord, December 20, 1884. 



Dr. Charles is fully impressed with the import- 
ance and practical reach of his subject, and he 
has treated it in a competent and instructive man- 
ner. We cannot recommend a better book than 
the present. In fact, it fills a gap in medical text- 
books, and that is a thing which can rarely be said 



HOFFMANN, F., A.M., JPh.JD., & POWER F.B., Ph.D., 

Public Analyst to the State of New York. Prof, of Anal. Chem. in the Phil. Coll. of Pharmacy. 

A Manual of Chemical Analysis, as applied to the Examination of Medicinal 
Chemicals and their Preparations. Being a Guide for the Determination of their Identity 
and Quality, and for the Detection of Impurities and Adulterations. For the use of 
Pharmacists, Physicians, Druggists and Manufacturing Chemists, and Pharmaceutical and 
Medical Students. Third edition, entirely rewritten and much enlarged. In one very 
handsome octavo volume of 621 pages, with 179 illustrations. Cloth, $4.25. 



We congratulate the author on the appearance 
of the third edition of this work, published for the 
first time in this country also. It is admirable and 
the information it undertakes to supply is both 
extensive and trustworthy. The selection of pro- 
cesses for determining the purity of the substan- 
ces of which it treats is excellent and the descrip- 



tion of them singularly explicit. Moreover, it is 
exceptionally free from typographical errors. We 
have no hesitation in recommending it to those 
who are engaged either in the manufacture or the 
testing of medicinal chemicals. — London Pharma- 
ceutical Journal and Transactions, 1883. 



CLOWES, FRANK, D. Sc, London, 

Senior Science- Master at the High School, Newcastle-under-Lyme, etc. 

An Elementary Treatise on Practical Chemistry and Qualitative 
Inorganic Analysis. Specially adapted for use in the Laboratories of Schools and 
Colleges and by Beginners. Third American from the fourth and revised English edition. 
In one very handsome royal 12mo. volume of 387 pages, with 55 illustrations. Cloth, 
$2.50. 



This work has long been a favorite with labora- 
tory instructors on account of its systematic plan, 
carrying the student step by step from the simplest 
questions of chemical analysis, to the more recon- 
dite problems. Features quite as commendable 
are the regularity and system demanded of the 



student in the performance of each analysis. 
These characteristics are preserved in the present 
edition, which we can heartily recommend as a sat- 
isfactory guide for the student of inorganic chem- 
ical analysis. — New York Medical Journal, Oct. 9, 



RALFE, CHARLES H., M. D., F. R. C. P., 

Assistant Physician at the London Hospital. 
Clinical Chemistry. In one pocket-size 12mo. volume of 314 pages, with 16 
illustrations. Limp cloth, red edges, $1.50. See Students' Series of Manuals, page 31. 

This is one of the most instructive little works 
that we have met with in a long time. The author 
is a physician and physiologist, as well as a chem- 
ist, consequently the book is unqualifiedly prac- 
what he ought to 



tical, telling the physician just 

know, of the applications of chemistry in medi- 



cine. Dr. Ralfe is thoroughly acquainted with the 
latest contributions to his science, and it is quite 
refreshing to find the subject dealt with so clearly 
and simply, yet in such evident harmony with the 
modern scientific methods and spirit. — Medical 
Record, February 2, 1884. 



CLASSEN, ALEXANDER, 

Professor in the Royal Polytechnic School, Aix-la-Chapelle. 

Elementary Quantitative Analysis. Translated, with notes and additions, by 
Edgar F. Smith, Ph. D., Assistant Professor of Chemistry in the Towne Scientific School, 
University of Penna. In one 12mo. volume of 324 pages, with 36 illus. Cloth, $2.00. 

It is probably the best manual of an elementary and then advancing to the analysis of minerals and 
nature extant, insomuch as its methods are the such products as are met with in applied chemis- 
best. It teaches by examples, commencing with try. It is an indispensable book for students in 
single determinations, followed by separations, chemistry.— Boston Journal of Chemistry, Oct. 1878. 



Lea Brothers & Co.'s Publications — Pharm., Mat. Med., Therap. 11 
BRUNTON, T. LAUDER, M.D., D.Sc, E.R.S., F.R.C.J?., 

Lecturer on Materia Medica and Therapeutics at St. Bartholomew's Hospital, London, etc. 

A Text-book of Pharmacology, Therapeutics and Materia Medica; 

Including the Pharmacy, the Physiological Action and the Therapeutical Uses of Drugs. 
Third edition. Octavo, 1305 pages, 230 illustrations. Cloth, $5\50 ; leather, $6.50. 

No word? of praise are needed for this work, for l parts, has appeared during the life of the present 
it has already spoken for itself in former editions. ! generation. This is strong language, but it is the 
It was by unanimous consent placed among the j truth. The great merit of this work is that tho 
foremost books on the subject ever published in | author has been able so well to coordinate facts 
any language, and the better it is known andstudied into an intelligible and rational system of pharma- 
the more highly it is appreciated. The present | cology, and henceforth no treatise on therapeutics 
edition contains much new matter, the insertion j will be considered complete which does not in 
of which has been necessitated by the advances | some measure adopt this method. The busy 
made in various directions in the art of therapeu- I physician will approach this book to learn some- 
tics, and it now stands unrivalled in its thoroughly ! thing that will better fit him for his work, and on 



scientific presentation of the modes of drug action 
No one who wishes to be fully up to the times in 
this science can afford to neglect the study of Dr. 
Brunton's work. The indexes are excellent, and 
add not a little to the practical value of the book. 
—Medical Record, May 25, 1889. 

Nothing so original and so complete on the action 
of drugs on the body generally an d on its various 



every page he will find something that will reward 
him for the time spent in its perusal. We com- 
mend this book as one which every physician 
should own and study. It is a work which if once 
owned will be likely to be read and consulted till 
the covers fall off from much use. — Boston Medical 
and Surgical Journal, Dec. 20, 1888. 



HARE, SOBART AMORY, B. Sc, M. D., 

Demonstrator of Therapeutics and Clinical Professor of Diseases of Children in the University of 
Pennsylvania; Secretary of the Convention for the Revision of the United States Pharmacopoeia of 
1890. 

A Text-Book of Practical Therapeutics ; With Especial Keference to the 
Application of Kemedial Measures to Disease and their Employment upon a Rational 
Basis. With special chapters by Drs. G. E. de Schweinitz, Edward Martin, 
J. Howard Reeves and Barton C. Hirst. In one handsome octavo volume of about 
700 pages. Shortly. 

The publishers take great pleasure in announcing the early appearance of a new work 
on Therapeutics, planned on lines which will secure for it a leading position as a text-book 
and work of reference. The author's large experience in experimental, didactic and 
clinical work, has peculiarly fitted him to produce a volume containing all that is latest 
and best in the application of remedial measures, and to present this material in a way 
which will not only impress it into the mind of the student firmly, because rationally, 
but which will also render it of daily service to practitioners by reason of its definite 
instructions as to the choice of various agents which may be employed. 

MAIS CRT, JOMWM., Fhar. D., 

Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. 
A Manual of Organic Materia Medica; Being a Guide to Materia Medica of 
the Vegetable and Animal Kingdoms. For the use of Students, Druggists, Pharmacists 
and Physicians. New (4th) edition, thoroughly revised. In one handsome royal 12mo. 
volume of 529 pages, with 258 illustrations. Cloth, $3. Just ready. 



For everyone interested in materia medica, 
Maisch's Manual, first published in 1882, and now 
in its fourth edition, is an indispensable book. 
For the American pharmaceutical student it is 
the work which will give him the necessary knowl- 
edge in the easiest way, partly because the text is 
brief, concise, and free from unnecessary matter, 
and partly because of the numerous illustrations, 
which bring facts worth knowing immediately be- 



fore his eyes. That it answers its purposes in this 
respect the rapid succession of editions is the best 
evidence. It is the favorite book of the American 
student even outside of Maisch's several hundred 
personal students. The arrangement of its con- 
tents shows the practical tendency of the book. 
Maisch's system of classification is easy and com- 
prehensive. — Pharmaceutische Zeitunq, Germany, 
1890. 



PARRISS, EDWARD 9 

Late Professor of the Theory and Practice of Pharmacy in the Philadelphia College of Pharmacy. 
A Treatise on Pharmacy : designed as a Text-book for the Student, and as a 
Guide for the Physician and Pharmaceutist. With many Formulae and Prescriptions. 
Fifth edition, thoroughly revised, by Thomas S. Wiegand, Ph. G. In one handsome 
octavo volume of 1093 pages, with 256 illustrations. Cloth, $5 ; leather, $6. 

No thorough-going pharmacist will fail to possess I ods of combination are concerned, can afford to 
himself of so useful a guide to practice, and no leave this work out of the list of their works of 
physician who properly estimates the value of an reference. The country practitioner, who must 
accurate knowledge of the remedial agents em- ' always be in a measure his own pharmacist, will 
ployed by him in daily practice, so far as their j find it indispensable. — Louisville Medical News, 
mxscibility, compatibility and most effective meth- | March 29, 1884. 



SERMAJVW, Dr. L., 

Professor of Physiology in the University of Zurich. 
Experimental Pharmacology. A Handbook of Methods for Determining the 
Physiological Actions of Drugs. Translated, with the Author's permission, and with 
extensive additions, by Kobert Meade Smith, M. D., Demonstrator of Physiology in the 
University of Pennsylvania. 12mo., 199 pages, with 32 illustrations. Cloth, $1.50. 

STILLE, ALFRED, M. D., LL. D., 

Professor of Theory and Practice of Med. and of Clinical Med. in the Univ. of Penna. 
Therapeutics and Materia Medica. A Systematic Treatise on the Action and 
Uses of Medicinal Agents, including their Description and History. Fourth edition, 
revised and enlarged. In two large and handsome octavo volumes, containing 1936 pages. 
Cloth, $10.00; leather, $12.00. 



12 Lea Brothers & Co.'s Publications — Mat. Med., Therap. 



STILLE, A., M. D., LL. I)., & MAISCLT, J. M., Fhar. JD., 



Professor Emeritus of the Theory and Prac- 
tice of Medicine and of Clinical Medicine 
in the University of Pennsylvania. 



Prof, of Mat. Med. and Botany in Phila. 
College of Pharmacy, Sec' y to the Ameri- 
can Pharmaceutical Association. 



The National Dispensatory. 

CONTAINING THE NATURAL HISTORY, CHEMISTRY, PHARMACY, ACTIONS AND USES OF 

MEDICINES, INCLUDING THOSE RECOGNIZED IN THE PHARMACOPEIAS OF THE 

UNITED STATES, GREAT BRITAIN AND GERMANY, WITH NUMEROUS 

REFERENCES TO THE FRENCH CODEX. 

Fourth edition revised, and covering the new British Pharmacopoeia. In one mag- 
nificent imperial octavo volume of 1794 pages, with 311 elaborate engravings. Price 
in cloth, $7.25 ; leather, raised bands, $8.00. *x*This work will be furnished with Patent 
Ready Reference Thumb-letter Index for $1.00 in addition to the price in any style of binding. 

In this new edition of The National Dispensatory, all important changes in the 
recent British Pharmacopoeia have been incorporated throughout the volume, while in 
the Addenda will be found, grouped in a convenient section of 24 pages, all therapeutical 
novelties which have been established in professional favor since the publication of the 
third edition two years ago. Since its first publication, The National, Dispensatory 
has been the most accurate work of its kind, and in this edition, as always before, it may 
be said to be the representative of the most recent state of American, English, German 
and French Pharmacology, Therapeutics and Materia Medica. 

It is with much pleasure that the fourth edition 
of this magnificent work is received. The authors 
and publishers have reason to feel proud of this, 
the most comprehensive, elaborate and accurate 
work of the kind ever printed in this country. It 
is no wonder that it has become the standard au- 
thority for both the medical and pharmaceutical 
profession, and that four editions have been re- 
quired to supply the constant and increasing 
demand since its first appearance in 1879. The 
entire field has been gone over and the various 
articles revised in accordance with the latest 
developments regarding the attributes and thera- 
peutical action of drugs. The remedies of recent 



discovery have received due attention. — Kansas 
City Medical Index, Nov. 1887. 

We think it a matter for congratulation that the 
profession of medicine and that of pharmacy have 
shown such appreciation of this great work as to call 
for four editions within the comparatively briel 
period of eight years. The matters with which it 
deals are of so practical a nature that neither the 
physician nor the pharmacist can do without the 
latest text-books on them, especially those that are 
so accurate and comprehensive as this one. The 
book is in every way creditable both to the authors 
and to the publishers. — New York Medical Journal, 
May 21, 1887. 



FARQTJHARSON, ROBERT, M. JD., F. R. C. P., LL. JD., 

Lecturer on Materia Medica at St. Martfs Hospital Medical School, London. 

A Guide to Therapeutics and Materia Medica. New (fourth) American, 
from the fourth English edition. Enlarged and adapted to the U. S. Pharmacopoeia. By 
Frank Woodbury, M. D., Professor of Materia Medica and Therapeutics and Clinical 
Medicine in the Medico-Chirurgical College of Philadelphia. In one handsome 12mo. 
volume of 581 pages. Cloth, $2.50. 

It may correctly be regarded as the most modern 
work of its kind. It is concise, yet complete. 
Containing an account of all remedies that have 
a place in the British and United States Pharma- 
copoeias, as well as considering all non-official but 
important new drugs, it becomes in fact a miniature 
dispensatory. — Pacific Medical Journal, June, 18s9. 

An especially attractive feature is an arrange- 
ment by which the physiological and therapeutical 



actions of various remedies are shown in parallel 
columns. This aids greatly in fixing attention and 
facilitates study. The American editor has en- 
larged the work so as to make it include all the 
remedies and preparations in the U. S. Pharma- 
copoeia. The book is a most valuable addition to 
the list of treatises on this most important subject. 
— American Practitioner and News, Nov. 9th, 1889. 



EDES, ROBERT T., M. !>., 

Jackson Professor of Clinical Medicine in Harvard University, Medical Department. 

A Text-Book of Therapeutics and Materia Medica. Intended for the 
Use of Students and Practitioners. Octavo, 544 pages. Cloth, $3.50 ; leather, $4.50. 



The present work seems destined to take a prom 
inent place as a text-book on the subjects of which 
it treats. It possesses all the essentials which we 
expect in a book of its kind, such as conciseness, 
clearness, a judicious classification, and a reason- 
able degree of dogmatism. All the newest drugs 
of promise are treated of. The clinical index at 
the end will be found very useful. We heartily 



commend the book and congratulate the author 
on having produced so good a one.— N. Y. Medical 
Journal, Feb. 18, 1888. 

Dr. Edes' book represents better than any older 
book the practical therapeutics of the present 
day. The book is a thoroughly practical one. The 
classification of remedies has reference to their 
therapeutic action.— Pharmaceutical Era, Jan. 1888. 



BRUCE, J. MITCHELL, M. L>., F. R. C. P., 

Physician and Lecturer on Materia Medica and Therapeutics at Charing Cross Hospital, London. 

Materia Medica and Therapeutics. An Introduction to Eational Treatment. 
Fourth edition. 12mo., 591 pages. Cloth, $1.50. See Students' Series of Manuals, page 31. 

GRIFFITH, ROBERT EGLESFIELJD, M. D. 

A Universal Formulary, containing the Methods of Preparing and Adminis- 
tering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceut- 
ists. Third edition, thoroughly revised, with numerous additions, by John M. Maisch, 
Phar.D., Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. 
In one octavo volume of 775 pages, with 38 illustrations Cloth, $4.50 ; leather, $5.50. 



Lea Brothers & Co.'s Publications — Pathol., Histol. 13 



GBEEN 9 T. HENBY 9 M. D. 9 

Lecturer on Pathology and Morbid Anatomy at Charing-Cross Hospital Medical School, London: - 
Pathology and Morbid Anatomy. New (sixth) American from the seventh 
revised English edition. Octavo, 539 pp., with 167 engravings. Cloth, $2.75. Just ready 



The Pathology and Morbid Anatomy of Dr. 
Oreen is too well known by members of the medi- 
cal profession to need any commendation. There 
is scarcely an intelligent physician anywhere who 
has not the work in his library, for it is almost an 
essential. In fact it is better adapted to the wants 
of general practitioners than any work of the kind 
with which we are acquainted. The works of 
German authors upon pathology, which have been 



translated into English, are too abstruse for the 
physician. Dr. Green's work precisely meets his 
wishes. The cuts exhibit the appearances of 
pathological structures just as they are seen 
through the microscope. The fact that it is so 
generally employed as a text-book by medical stu- 
dents is evidence that we have not spoken too 
much in its favor.— Cincinnati Medical News, Oct. 
1889. 



PAYNE, JOSEPH F., M. JD. 9 F. B. C. F. 9 

Senior Assistant Physician and Lecturer on Pathological Anatomy, St. Thomas' Hospital, London. 
A Manual of General Pathology. Designed as an Introduction to the Prac- 
tice of Medicine. Octavo of 524 pages, with 152 illus. and a colored plate. Cloth, $3.50. 
Knowing, as a teacher and examiner, the exact j cal factors in those diseases now with reasonable 
needs of medical students, the author has in the ! certainty ascribed to pathogenetic microbes. In 
work before us prepared for their especial use j this department he has been very full and explicit, 
what we do not hesitate to say is the best introduc- ! not only in a descriptive manner, but in the tech- 
tion to general pathology that we have yet ex- j nique of investigation. The Appendix, giving 
amined. A departure which our author has methods of research, is alone worth the price of the 
taken is the greater attention paid to the causa- book, several times over, to every student of 
tion of disease, and more especially to the etiologi- | pathology. — St.Louis Med. and Surg. Jour., Jan. '89. 

SENN 9 NICHOLAS, M.JD. 9 Fh.JD. 9 

Professor of Principles of Surgery and Surgical Pathology in Rush Medical College, Chicago. 
Surgical Bacteriology. In one handsome octavo of 259 pages, with 13 plates,, 
of which 9 are colored. Cloth, $1.75. 

COATS, JOSEFH, M. I)., F. F. F. S. 9 

Pathologist to the Glasgow Western Infirmary. 
A Treatise on Pathology. In one very handsome octavo volume of 829 pages, 
with 339 beautiful illustrations. Cloth, $5.50 ; leather, $6.50. 

Medical students as well as physicians, who I manner, the changes from a normal condition 
desire a work for study or reference, that treats j effected in structures by disease, and points out 
the subjects in the various departments in a very the characteristics of various morbid agencies, 
thorough manner, but without prolixity, will cer- l so that they can be easily recognized. But, not 
tainly give this one the preference to any with ■ limited to morbid anatomy, it explains fully how 
which we are acquainted. It sets forth the most • the functions of organs are disturbed by abnormal 
recent discoveries, exhibits, in an interesting | conditions.— Cincinnati Medical News, Oct. 1883. 



WOODHEAD, G. SIMS, M. !>., F. It. C. F. E. 9 

Demonstrator of Pathology in the University of Edinburgh. 
Practical Pathology. A Manual for Students and Practitioners. In one beau- 
tiful octavo volume of 497 pages, with 136 exquisitely colored illustrations. Cloth, $6.00. 



It forms a real guide for the student and practi- 
tioner who is thoroughly in earnest in his en- 
deavor to see for himself and do for himself. To 
the laboratory student it will be a helpful com- 

f »anion, and all those who may wish to familiarize 
hemselves with modern methods of examining 
morbid tissues are strongly urged to provide 



themselves with this manual. The numerous 
drawings are not fancied pictures, or merely 
schematic diagrams, but they represent faithfully 
the actual images seen under the microscope. 
The author merits all praise for having produced 
a valuable work.— Medical Record, May 31, 1884. 



SCHAFEB 9 EDWABD A., F. B. S. 9 

Jodrell Professor of Physiology in University College, London. 

The Essentials of Histology. In one octavo volume of 246 pages, with 

281 illustrations. Cloth, $2.25. 

This admirable work was greatly needed. It I cially adapted for laboratory work, at the same 
has been written with the object of supplying t time it is intended to serve as an elementary 
the student with directions for the microscopical | text-book of histology, comprising all the essen- 
examination of the tissues, which are given in a ] tial facts of the science. — The Physician and Sur~ 
clear and understandable way. Although espe- | geon, July, 1887. 

KLEIN 9 E. 9 M. D. 9 F. B. S. 9 

Joint Lecturer on General Anat. and Phys. in the Med. School of St. Bartholomew's Hosp., London. 
Elements of Histology. Fourth edition. In one 12mo. volume of 376 pages, 
with 194 illus. Limp cloth, $1.75. See Students' Series of Manuals, page 31. 

Considered with regard to its contents, it can j index affords a ready reference to the histology of 
only be looked on as a large and comprehensive | every tissue and organ, and presents, at the same 
volume. New and original illustrations have been | time, a complete glossary of the scientific terms. — 
added, with the help of which the structure of each Provincial Medical Journal, May 1, 1889. 
tissue becomes clear to the reader. A copious I 



FEFFEB 9 A. J., M. B. 9 M. S. 9 F. B. C. S. 9 

Surgeon and Lecturer at St. Mary's Hospital, London. 
Surgical Pathology. In one pocket-size 12mo. volume of 511 pages, with 81 
illustrations. Limp cloth, red edges, $2.00. See Students' Series of Manuals, page 31. 

Its form is practical, its language is clear, and I in it nothing that is unnecessary. The list o f 
the information set forth is well-arranged, well- subjects covers the whole range of surgery. — New 
indexed and well-illustrated. The student will find | York Medical Journal, May 31, 1884. 



14 



Lea Brothers & Co.'s Publications — Practice of Med. 



FLINT, AUSTIN, M. D., LL. D. 

Prof, of the Principles and Practice of Med. and of Clin. Med. in Bellevue Hospital Medical College, N. Y. 

A Treatise on the Principles and Practice of Medicine. Designed for 
the use of Students and Practitioners of Medicine. New (sixth) edition, thoroughly re- 
vised and rewritten by the Author, assisted by William H. Welch, M. D., Professor of 
Pathology, Johns Hopkins University, Baltimore, and Austin Flint, Jr., M. D., LL. D., 
Professor of Physiology, Bellevue Hospital Medical College, N. Y. In one very handsome 
octavo volume of 1160 pages, with illustrations. Cloth, $5.50 ; leather, $6.50. 



A new edition of a work of such established rep- 
utation as Flint's Medicine needs but few words to 
commend it to notice. It may in truth be said to 
embody the fruit of his labors in clinical medicine, 
ripened by the experience of a long life devoted to 
its pursuit. America may well be proud of having 
produced a man whose indefatigable industry and 
g if ts of genius have done so much to advance med- 
cine; and all English-reading students must be 
grateful for the work which he has left behind him. 
It has few equals, either in point of literary excel- 
lence, or of scientific learning, and no one can 
study its pages without being struck by the lu- 
cidity and accuracy which characterize them. It 
is qualities such as these which render it so valu- 
able for its purpose, and give it a foremost place 
^mong the text-books of this generation. — The 
London Lancet, March 12, 1887. 
f- No text-book on the principles and practice of 
medicine has ever met in this country with such 



general approval by medical students and practi- 
tioners as the work of Professor Flint. In all the 
medical colleges of the United States it is the fa- 
vorite work upon Practice; and, as we have stated 
before in alluding to it, there is no other medical 
work that can be so generally found in the libra- 
ries of physicians. In every state and territory 
of this vast country the book that will be most likely 
to be found in the office of a medical man, whether 
in city, town, village, or at some cross-roads, is 
Flint's Practice. We make this statement to a 
considerable extent from personal observation, and 
it is the testimony also of others. An examina- 
tion shows that very considerable changes have 
been made in the sixth edition. The work may un- 
doubtedly be regarded as fairly representing the 
present state of the science of medicine, and as 
reflecting the views of those who exemplify in 
their practice the present stage of progress of med- 
ical art. — Cincinnati Medical News, Oct. 1886. 



HARTSHORNE, HENRY, M. D., LL. I)., 

Lately Professor of Hygiene in the University of Pennsylvania. 

Essentials of the Principles and Practice of Medicine. A Handbook 
f or Students and Practitioners. Fifth edition, thoroughly revised and rewritten. In one 
royal 12mo. volume of 669 pages, with 144 illustrations. Cloth, $2.75 ; half bound, $3.00. 



*"- Within the compass of 600 pages it treats of the 
history of medicine, general pathology, general 
symptomatology, and physical diagnosis (including 
laryngoscope, ophthalmoscope, etc.), general ther- 
apeutics, nosology, and special pathology and prac- 
tice. There is a wonderful amount of information 
contained in this work, and it is one of the best 
of its kind that we have seen. — Glasgow Medical 
Journal, Nov. 1882. 

An indispensable book. No work ever exhibited 
a better average of actual practical treatment than 



this one; and probably not one writer in our day 
had a better opportunity than Dr. Hartshorne for 
condensing all the views of eminent practitioners 
into a 12mo. The numerous illustrations will be 
very useful to students especially. These essen- 
tials, as the name suggests, are not intended to 
supersede the text-books of Flint and Bartholow, 
but they are the most valuable in affording the 
means to see at a glance the whole literature of any 
disease, and the most valuable treatment. — Chicago 
Medical Journal and Examiner, April, 1882. 



REYNOLDS, J. RUSSELL, M. I)., 

Professor of the Principles and Practice of Medicine in University College, London. 
A System of Medicine. With notes and additions by Henry Hartshorne, 
A. M., M. D., late Professor of Hygiene in the University of Pennsylvania. In three large 
and handsome octavo volumes, containing 3056 double-columned pages, with 317 illustra- 
tions. Price per volume, cloth, $5.00 ; sheep, $6.00 ; very handsome half Russia, raised bands, 
$6.50. Per set, clotb, $15; leather, $18. Sold only by subscription. 

Really too much praise can scarcely be given to 
this noble book. It is a cyclopaedia of medicine 
written by some of the best men of Europe. It is 
full of useful information, such as one finds fre- 
quent need of in one's daily work. As a book 



of reference it is invaluable. It is up with the 
times. It is clear and concentrated in style, and 
its form is worthy of its famous publisher. — 
Louisville Medical News, Jan. 31, 1880. 



S1ILLJE, ALFRED, M. D., LL. D., 

Professor Emeritus of the Theory and Practice of Med. and of Clinical Med. in the Univ. of Penna. 
Cholera : Its Origin, History, Causation, Symptoms, Lesions, Prevention and Treat- 
ment. In one handsome 12mo. volume of 163 pages, with a chart. Cloth, $1.25. 



WATSON, SIR THOMAS, M. D., 

Late Physician in Ordinary to the Queen. 

Lectures on the Principles and Practice of Physic. A new American 
from the fifth English edition. Edited, with additions, and 190 illustrations, by Henry 
Hartshorne, A. M., M. D., late Professor of Hygiene in the University of Pennsylvania. 
In two large octavo volumes of 1840 pages. Cloth, $9.00 ; leather, $11.00. 



LECTURES ON THE STUDY OF FEVER. By i 
A. Hudson, M. D., M. R. I. A. In one octavo 
volume of 308 pages. Cloth, $2.50. 

A. TREATISE ON FEVER. By Robeet D. Lyons, 
K. C. C. In one 8vo. vol. of 354 pp. Cloth, 82.25. 



In 



BRISTOWE'S PRACTICE OF MEDICINE, 
one octavo volume. 

LA ROCHE ON YELLOW FEVER, considered in 
its Historical, Pathological, Etiological and 
Therapeutical Relations. In two large and hand- 
some octavo volumes of 1468 pp. Cloth, $7.00. 



Lea Brothers & Co.'s Publications — System of Med. 15 



For Sale by Subscription Only. 



A System of Practical Medicine. 

BY AMERICAN AUTHORS. 
Edited by WILLIAM PEPPER, M. D., LL. D., 

PROVOST AND PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE AND OF 
CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA, 

Assisted by Lours Starr, M. D., Clinical Professor of the Diseases of Children in the 
Hospital of the University of Pennsylvania. 

The complete work, in five volumes, containing 5573 pages, with 198 illustrations, is now ready. 
Price per volume, cloth, $5; leather, $6 ; half Russia, raised bands and open back, $7. 

In this great work American medicine is for the first time reflected by itsworthiest 
teachers, and presented in the full development of the practical utility which is its pre- 
eminent characteristic. The most able men — from the East and the West, from the 
North and the South, from all the prominent centres of education, and from all the 
hospitals which afford special opportunities for study and practice — have united J in 
generous rivalry to bring together this vast aggregate of specialized experience. .- .r^j 

The distinguished editor has so apportioned the work that to each author has been 
assigned the subject which he is peculiarly fitted to discuss, and in which his views 
will be accepted as the latest expression of scientific and practical knowledge. The 
practitioner will therefore find these volumes a complete, authoritative and unfailing work, 
of reference, to which he may at all times turn with full certainty of finding what he needs 
in its most recent aspect, whether he seeks information on the general principles of medi- 
cine, or minute guidance in the treatment of special disease. So wide is the scope of the 
work that, with the exception of midwifery and matters strictly surgical, it embraces the 
whole domain of medicine, including the departments for which the physician is accustomed 
to rely on special treatises, such as diseases of women and children, of the genito-urinary 
organs, of the skin, of the nerves, hygiene and sanitary science, and medical ophthalmology 
and otology. Moreover, authors have inserted the formulas which they have found most 
efficient in the treatment of the various affections. It may thus be truly regarded as a 
Complete Library of Practical Medicine, and the general practitioner possessing it 
may feel secure that he will require little else in the daily round of professional duties. 

In spite of every effort to condense the vast amount of practical information fur- 
nished, it has been impossible to present it in less than 5 large octavo volumes, containing 
about 5600 beautifully printed pages, and embodying the matter of about 15 ordinary 
octavos. Illustrations are introduced wherever requisite to elucidate the text. 

A detailed prospectus will be sent to any address on application to the publishers^ 

These two volumes bring this admirable work I physicians who are acquainted with all the varie- 
to a close, and fully sustain the high standard ties of climate in the United States, the character 
reached by the earlier volumes ; we have only i of the soil, the manners and customs of the peo- 
therefore to echo the eulogium pronounced upon | pie, etc., it is peculiarly adapted to the wants 
them. We would warmly congratulate the editor | of American practitioners of medicine, and it 
and his collaborators at the conclusion of their seems to us that every one of them would desire 
laborious task on the admirable manner in which, to have it. It has been truly called a "Complete 
from first to last, they have performed their several Library of Practical Medicine," and the general 
duties. They have succeeded in producing a practitioner will require little else in his round 
work which will long remain a standard work of of professional duties. — Cincinnati Medical IVetcs, 
reference, to which practitioners will look for March, 1886. 
guidance, and authors will resort for facts. Each of the volumes is provided with a most 



From a literary point of view, the work is without 
any serious blemish, and in respect of production, 
it has the beautiful finish that Americans always 
give their works.— Edinburgh Medical Journal, Jan. 
1887. 

* * The greatest distinctively American work on 
the practice of medicine, and, indeed, the super- 
lative adjective would not be inappropriate were 
even all other productions placed in comparison. 
An examination of the five volumes is sufficient 



copious index, and the work altogether promises 
to be one which will add much to the medical 
literature of the present century, and reflect great 
credit upon the scholarship and practical acumen 
of its authors.— The London Lancet, Oct. 3, 1885. 

The feeling of proud satisfaction with which the 
American profession sees this, its representative 
system of practical medicine issued to the medi- 
cal world, is fully justified by the character of the 
work. The entire caste of the system is in keep- 



to convince one of the magnitude of the enter- ing with the best thoughts of the leaders and fol- 
prise, and of the success which has attended its I lowers of our home school of medicine, and the 
fulfilment.— The Medical Age, July 26, 1886. I combination of the scientific study of disease and 



This huge volume forms a fitting close to the 

freat system of medicine which in so short a time 
as won so high a place in medical literature, and 
has done such credit to the profession in this 
country. Among the twenty-three contributors 
are the names of the leading neurologists in 
America, and most of the work in the volume is of 



the practical application of exact and experimen- 
tal knowledge to the treatment of human mal- 
adies, makes every one of us share in the pride 
that has welcomed Dr. Pepper's labors. Sheared 
of the prolixity that wearies the readers of the 
German school, the articles glean these same 
fields for all that is valuable. It is the outcome 



the highest order.— Boston Medical and Surgical of American brains, and is marked throughout 
Journal, July 21, 1887. by much of the sturdy independence of thought 



We consider it one of the grandest works on 
Practical Medicine in the English language. It is 
a work of which the profession of this country can 
feel proud. Written exclusively by American 



and originality that is a national characteristic. 
Yet nowhere is there lack of study of the most 
advanced views of the day.— North Carolina Medi- 
cal Journal, Sept. 1886. 



16 



Lea Brothers & Co.'s Publications — Clinical Med., etc. 



FOTHEHGILL, J. M., M. ID., Edin., M. M. C. P., Lond., 

Physician to the City of London Hospital for Diseases of the Chest. 

The Practitioner's Handbook of Treatment ; Or, The Principles of Thera- 
peutics. New (third) edition. In one 8vo. vol. of 661 pages. Cloth, $3.75 ; leather, $4.75. 

This is a wonderful book. If there be such a 
thing as " medicine made easy," this is the work to 
accomplish this result.— Fa. Med. Month., June,'87. 



To have a description of the normal physiologi- 
cal processes of an organ and of the methods of 
treatment of its morbid conditions brought 
together in a single chapter, and the relations 
between the two clearly stated, cannot fail to prove 
a great convenience to many thoughtful but busy 
physicians. The practical value of the volume is 
greatly increased by the introduction of many 
prescriptions. That the profession appreciates 
that the author has undertaken an important work 
and has accomplished it is shown by the demand 
f or this third edition.— N. Y. Med. Jour., June 11,'87. 



It is an excellent, practical work on therapeutics, 
well arranged and clearly expressed, useful to the 
student and young practitioner, perhaps even to 
the old.— Dublin Journal of Medical Science, March, 
1888. 

We do not know a more readable, practical and 
useful work on the treatment of disease than the 
one we have now before us.— Pacific Medical and 
Surgical Journal, October, 1887. 



VAUGHA1T, VIC TOM C, Ph. D., M. Z>., 

Prof, of Phys. and Path. Chem. and Assoc. Prof, of Therap. and Mat. Med. in the Univ. of Mich. 

and JTOVY, FBEDEBICK G., M. D. 

Instructor in Hygiene and Phys. Chem. in the Univ. of Mich. 

Ptomaines and Leucomaines, or Putrefactive and Physiological 
Alkaloids. In one handsome 12mo. volume of 311 pages. Just ready. Cloth, $1.75. 
This book is what has been wanted for some | observers and experimenters on micro-organisms, 



years by the medical profession. The subject of 
ptomaines and leucomaines, so far as their disease- 
producing relations are concerned, has been under 
special study scarcely more than a decade, but 
within that period facts have been discovered 
upon which theories of permanent standing have 
been built, until now the practitioner is far be- 
hind the times if he does not appreciate the 
importance of ptomaines. This is the first attempt 
made to collect into book form the results of 



and to trace the relationship of cause and effect 
of the putrefactive alkaloids. We congratulate 
the authors upon the successful presentation ot 
the current views on the subject iu such manner 
as to make them easily comprehensible, while to 
the practitioner, after he has carefully read the 
book, it will serve, also, as a frequent reference 
work, because of the technical information it gives. 
Va. Medical Monthly, Sept. 1888. 



FINLAYSON, JAMES, M. JD. 9 Editor, 

Physician and Lecturer on Clinical Medicine in the Glasgow Western Infirmary, etc. 

Clinical Manual for the Study of Medical Cases. With Chapters 
by Prof. Gairdner on the Physiognomy of Disease ; Prof. Stephenson on Diseases of 
the Female Organs ; Dr. Eobertson on Insanity ; Dr. Gem m ell on Physical Diagnosis ; 
Dr. Coats on Laryngoscopy and Post-Mortem Examinations, and by the Editor on Case- 
taking, Family History and Symptoms of Disorder in the Various Systems. New edition. 
In one 12mo. volume of 682 pages, with 158 illustrations. Cloth, $2.50. 

treatise on medical diagnosis, in which every sign 
and symptom of disease is carefully analyzed, and 
their relative significance in the different affec- 
tions in which they occur pointed out. From their 
synthesis the student can accurately determine 
the disease with which he has to deal. The book 
has no competitor, nor is it likely to have as long 
as future editions maintain its present standard of 
excellence. The general practitioner will find 
many practical hints in its pages, while a careful 
study of the work will save him from many pitfalls 
in diagnosis. — Liverpool Medico- Chirurgical Jour- 
nal, January, 1887. 



The profession cannot but welcome the second 
edition of this very valuable work of Finlayson 
and his collaborators. The size of the book has 
been increased and the number of illustrations 
nearly doubled. The manner in which the subject 
is treated is a most practical one. Symptoms 
alone and their diagnostic indications form the 
basis of discussion. The text explains clearly and 
fully the methods of examinations and the con- 
clusions to be drawn from the physical signs.— 
The Medical News, April 23, 1887. 

We are pleased to see a second edition of thia 
admirable book. It is essentially a practical 



FENWICK, SAMUEL, M. D., 

Assistant Physician to the London Hospital. 

The Student's Guide to Medical Diagnosis. From the third revised and 
enlarged English edition. In one very handsome royal 12mo. volume of 328 pages, with 
87 illustrations on wood. Cloth, $2.25. 

ELABEKSHON, S. O., M. Z>., 

Senior Physician to and late Led. on Principles and Practice of Med. at Ghuy's Hospital, London. 

On the Diseases of the Abdomen ; Comprising those of the Stomach, and 
other parts of the Alimentary Canal, (Esophagus, Caecum, Intestines and Peritoneum. Second 
American from third enlarged and revised English edition. In one handsome octavo 
volume of 554 pages, with illustrations. Cloth, $3.50. 
This valuable treatise on diseases of the stomach | to the times, and making it a volume of interest to 



and abdomen will be found a cyclopaedia of infor 
mation, systematically arranged, on all diseases of 
the alimentary tract, from the mouth to the 
rectum. A fair proportion of each chapter is 
devoted to symptoms, pathology, and therapeutics. 
The present edition is fuller than former ones in 
many particulars, and has been thoroughly revised 
and amended by the author. Several new chap- 
ters have been added, bringing the work fully up 



the practitioner in every field of medicine and 
surgery. Perverted nutrition is in some form 
associated with all diseases we have to combat, 
and we need all the light that can be obtained on 
a subject so broad and general. Dr. Habershon's 
work is one that every practitioner should read 
and study for himself.— N. Y. Medical Journal, 
April, 1879. 



TANJSTEB, THOMAS HAWKES, M. Z>. 

A Manual of Clinical Medicine and Physical Diagnosis. Third American 
f rom the second London edition. Kevised and enlarged by Tilbury Fox, M. D. 
In one small 12mo. volume of 362 pages, with illustrations. Cloth, $1.50. 



Lea Brothers & Co.'s Publications — Hygiene, Electr., Pract. 17 



BARTHOLOW, ROBERTS, A. M., M. JD., LL. JD., 

Prof, of Materia Medica and General Therapeutics in the Jefferson Med. Coll. of Phila., etc. 
' Medical Electricity. A Practical Treatise on the Applications of Electricity 
to Medicine and Surgery. New (third) edition. In one very handsome octavo volume of 
308 pages, with 110 illustrations. Cloth, $2.50. 



The fact that this work has reached its third edi- 
tion in six years, and that it has been kept fully 
abreast with the increasing use and knowledge of 
electricity,demonstrates its claim to be considered 
a practical treatise of tried value to the profession. 
The matter added to the present edition embraces 
the most recent advances in electrical treatment. 
The illustrations are abundant and clear, and the 
work constitutes a full, clear and concise manual 
well adapted to the needs of both student and 
practitioner.— The Medical News, May 14, 1887. 

This "practical treatise on the applications of 
electricity to medicine and surgery" has grown to 
be so important a work that every practitioner 



should read it, especially when it is recalled what 
possibilities lie in the path of the further study of 
the therapeutics of electricity. Dr. Bartholow has 
here presented the profession with a concise work 
that, beginning with elementary descriptions and 
principles, gradually grows, page by page, into a 
magnificently practical treatise, describing opera- 
tions in detail, and giving records of successes 
that prove electricity to be marvellous as a curative 
agent in many forms of disease. The doctor can- 
not now do better than to possess himself of Dr. 
Bartholow's treatise, just as it is.— Virginia Medi- 
cal Monthly, June, 1887. 



YJEO, I. BURNEY, M. IK, F. R. 

Professor of Clinical Therapeutics in King's College, 
Hospital. 

Food in Health and Disease. In one 12mo. volume of 590 pages. 
Just ready. See Series of Clinical Manuals, page 31. 



a p., 

London, and Physician to King's College 
Cloth, $2. 



Dr. Yeo is fully master of his subject and he 
supplies in a compact form nearly all that the 
practitioner requires to know on the subject of 
diet. The work is divided into two parts— food in 
health and food in disease. Dr. Yeo has gathered 
together from all quarters an immense amount of 
useful information within a comparatively small 



compass, and he has arranged and digested his 
materials with skill for the use of the practitioner. 
We have seldom seen a book which more thor- 
oughly realizes the object for which it was written 
than this little work of Dr. Yeo.— British Medical 
Journal, Feb. 8, 1890. 



RICHARDSON, B. W., M.I)., LL. I)., F.R.S., 

Fellow of the Royal College of Physicians, London. 
Preventive Medicine. In one octavo volume of 729 pages. Cloth, $4; leather, $5. 

the question of disease is comprehensive, masterly 



Dr. Richardson has succeeded in producing a 
work which is elevated in conception, comprehen- 
sive in scope, scientific in character, systematic in 
arrangement, and which is written in a clear, con- 
cise and pleasant manner. He evinces the happy 
faculty of extracting the pith of what is known on 
the subject, and of presenting it in a most simple, 
intelligent and practical form. There is perhaps 
no similar work written for the general public 
that contains such a complete, reliable and instruc- 
tive collection of data upon the diseases common 
to the race, their origins, causes, and the measures 
for their prevention. The descriptions of diseases 
are clear, chaste and scholarly ; the discussion of 



and fully abreast with the latest and best knowl- 
edge on the subject, and the preventive measures 
advised are accurate, explicit and reliable.— The 
American Journal of the Medical Sciences, April, 1884. 

This is a book that will surely find a place on the 
table of every progressive physician. To the medi- 
cal profession, whose duty is quite as much to 
prevent as to cure disease, the book will be a boon. 
— Boston Medical and Surgical Journal, March 6, '84. 

The treatise contains a vast amount of solid, val- 
uable hygienic information.— Medical and Surgical 
Reporter, Feb. 23, 1884. 



THE YEAR-BOOK OF TREATMENT FOR 1890. 

A Comprehensive and Critical Review for Practitioners of Medi- 
cine. In one 12mo. volume of 329 pages. Cloth, $1.25. Just ready. 
x\ For special commutations with periodicals see page 2. 



In the present issue of the Year-Book of Treat- 
ment we find the usual clear, concise, complete 
and accurate epitome of the chief advances made 
in the treatment of disease during the year end 
ing Sept. 1st. The different subjects are arranged 
in sections under the heads of the principal sys- 
tems of the body. The serial medical literature 
of England, America and of the Continent has 
been laid under contribution, with the result that 



a large mass of information, valuable to the prac- 
titioner, is presented for his immediate reference. 
Brief notices of the most important new books on 
each subject add greatly to the value of the annual 
retrospect. Such a book, produced as it is in an 
elegant and convenient form and at a very low 
price, ought to be in the hands of every member 
of the profession. — The Practitioner, Feb. 1890. 



THE YEAR- BOOKS of TREATMENT for 1886-87-89. 

Similar to above. 12mo., 320-341 pages. Limp cloth, $1.25 each. 

SCHREIBER, JOSEPH, M. D. 

A Manual of Treatment by Massage and Methodical Muscle Ex- 
ercise. Translated by Walter Mendelson, M. D., of New York. In one handsome 
octavo volume of 274 pages, with 117 fine engravings. Cloth, $2.75. 



STURGES' INTRODUCTION TO THE STUDY 
OF CLINICAL MEDICINE. Being a Guide to 
the Investigation of Disease. In one handsome 
12mo. volume of 127 pages. Cloth, $1.25. 

DAVIS' CLINICAL LECTURES ON VARIOUS 
IMPORTANT DISEASES. By N. S. Davis. 
M. D. Edited by Frank H. Davis, M. D. Second 
edition. 12mo. 287 pages. Cloth, $1.75. 

TODD'S CLINICAL LECTURES ON CERTAIN 
ACUTE DISEASES. In one octavo volume of 
S20 pages. Cloth, $2.50. 



PAVY'S TREATISE ON THE FUNCTION OF DI- 
GESTION; its Disorders and their Treatment. 
From the second London edition. In one octavo 
volume of 238 pages. Cloth, $2.00. 

BARLOW'S MANUAL OF THE PRACTICE OF 
MEDICINE. With additions by D. F. Condie, 
M. D. 1 vol. 8vo., pp. 603. Cloth, $2.50. 

CHAMBERS' MANUAL OF DIET AND REGIMEN 
IN HEALTH AND SICKNESS. In one hand- 
some octavo volume of 302 pp. Cloth, $2.75. 

HOLLAND'S MEDICAL NOTES AND REFLEC- 
TIONS. 1 vol. 8vo., pp. 493. Cloth, $3.50. 



18 Lea Brothers & Co.'s Publications — Throat, Lungs, Heart. 



FLINT, AUSTIN, M. JD., LI. JD., 

Professor of the Principles and Practice of Medicine in Bellevue Hospital Medical College, N. Y. 

A Manual of Auscultation and Percussion ; Of the Physical Diagnosis of 
Diseases of the Lungs and Heart, and of Thoracic Aneurism. New (fifth) edition. 
Edited by James C. Wilson, M. D., Jefferson Medical College, Philadelphia. In one 
handsome royal 12mo. volume of about 300 pages, with 14 illustrations. Preparing. 
A notice of the previous edition is appended. 

passed through four editions attests its popularity. 
There is a tendency among physical diagnosti- 
cians to make altogether too many varieties of 



The original work done by Dr. Flint in the devel 
opmentof the art of physical diagnosis will always 
make this manual an authority on this subject. 
Among all the works issued on this topic during 
the last few years, none exceeds this one in sim- 
plicity and completeness. The fact that it has 



morbid chest sounds, and especially of rales. The 
conciseness of Dr. Flint's Manual is one of its chief 
advantages — Medical Record, June 16, 1888. 



B 7 THE SAME A UTHOR. 



A Practical Treatise on the Physical Exploration of the Chest and 
the Diagnosis of Diseases Affecting the Respiratory Organs. Second and 
revised edition. In one handsome octavo volume of 591 pages. Cloth, $4.50. 

Phthisis: Its Morbid Anatomy, Etiology, Symptomatic Events and 
Complications, Fatality and Prognosis, Treatment and Physical Diag- 
nosis ; In a series of Clinical Studies. In one octavo volume of 442 pages. Cloth, $3.50. 

A Practical Treatise on the Diagnosis, Pathology and Treatment of 
Diseases of the Heart. Second revised and enlarged edition. In one octavo volume 
of 550 pages, with a plate. Cloth, $4. 



Essays on Conservative Medicine and Kindred Topics. 

some royal 12mo. volume of 210 pages. Cloth, $1.38. 



In one very hand- 



BROWNE, LENNOX, F. B. C. S., E., 

Senior Physician to the Central London Throat and Ear Hospital. 

A Practical Guide to Diseases of the Throat and Nose, including 
Associated Affections of the Ear. With 120 illustrations in color, and 235 en- 
gravings on wood. New (third) and enlarged edition. In one imperial octavo volume 
of 714 pages. Cloth, $6.50. Just ready. 



SEILEB, CABL, M. JD., 

Lecturer on Laryngoscopy in the University of Pennsylvania. 

A Handbook of Diagnosis and Treatment of Diseases of the Throat, 
Nose and Naso-Pharynx. New (third) edition. In one handsome royal 12mo. 
volume of 373 pages, with 101 illustrations and 2 colored plates. Cloth, $2.25. 

Few medical writers surpass this author in I of topics and methods. The book deserves a large 
ability to make his meaning perfectly clear in a sale, especially among general practitioners— Chi- 
few words, and in discrimination in selection, both | cago Medical Journal and Examiner, April, 1889. 



COHEN, J. SOLIS, M. L>., 

Lecturer on Laryngoscopy and Diseases of the Throat and Chest in the Jefferson Medical College. 

Diseases of the Throat and Nasal Passages. A Guide to the Diagnosis and 
Treatment of Affections of the Pharynx, (Esophagus, Trachea, Larynx and Nares. Third 
edition, thoroughly revised and rewritten, with a large number of new illustrations. In 
one very handsome octavo volume. Preparing. 



GBOSS, S. D., M.D., LL.JD., JD.C.L. Oxon., LL.D. Cantab. 

A Practical Treatise on Foreign Bodies in the Air-passages. In one 

octavo volume of 452 pages, with 59 illustrations. Cloth, $2.75. 



BBOAJDBENT, W. HJ., M. JD., F. B. C. JP., 

Physician to and Lecturer on Medicine at St. Mary's Hospital, London. 
The Pulse. In one 12mo. volume of 312 pages. Cloth, $1.75. 
Series of Clinical Manuals, page 31. 



Just ready. See 



FULLER ON DISEASES OF THE LUNGS AND 
AIR-PASSAGES. Their Pathology, Physical Di- 
agnosis, Symptoms and Treatment. From the 
second and revised English edition. In one 
octavo volume of 475 pages. Cloth, $3.50. 

WALSHE ON THE DISEASES OF THE HEART 
AND GREAT VESSELS. Third American edi- 
tion. In 1 vol. 8vo., 416 pp. Cloth, $3.00. 

SLADE ON DIPHTHERIA; its Nature and Treat- 
ment, with an account of the History of its Pre- 



valence in various Countries. Second and revised 
edition. In one 12mo. vol., pp. 158. Cloth, $1.25. 

SMITH ON CONSUMPTION; its Early and Reme- 
diable Stages. 1 vol. 8vo., pp. 253. Cloth, $2.25. 

LA ROCHE ON PNEUMONIA. 1 vol. 8vo. of 490 
nages. Cloth, $3.00. 

WILLIAMS ON PULMONARY CONSUMPTION; 
its Nature, Varieties and Treatment. With an 
analysis of one thousand cases to exemplify its 
duration. In one 8vo. vol. of 303 pp. Cloth, $2.50 



Lea Brothers & Co.'s Publications — Nerv. and Ment. Dis., etc. 19 



one octavo 



MOSS, JAMBS, M.D., F.B. C.F., LL.JD., 

Senior Assistant Physician to the Manchester Royal Infirmary. 

A Handbook on Diseases of the Nervous System. In 

volume of 725 pages, with 184 illustrations. Cloth, $4.50; leather,'$5.50. 

This admirable work is intended for students of 
medicine and for such medical men as have no time 
for lengthy treatises. In the present instance the 
duty of arranging the vast store of material at the 
disposal of the author, and of abridging the de- 
scription of the different aspects of nervous dis- 
eases, has been performed with singular skill, and 
the result is a concise and philosophical guide to 



the department of medicine of which it treats. 
Dr. Ross holds such a high scientific position that 
any writings which bear his name are naturally 
expected to have the impress of a powerful intel- 
lect. In every part this handbook merits tUe 
highest praise, and will no doubt be found ot the 
greatest value to the student as well as to the prac- 
titioner. — Edinburgh Medical. Journal, Jan. 1887. 



MITCHELL, s. weir, m. jo., 

Physician to Orthoposdic Hospital and the Infirmary for Diseases of the Nervous System, Phila., etc. 

Lectures on Diseases of the Nervoiis System; Especially in Women. 
Second edition. In one 12mo. volume of 288 pages. Cloth, $1.75. 

No work in our language develops or displays 
more features of that many-sided affection, hys- 
teria, or gives clearer directions for its differen- 
tiation, or sounder suggestions relative to its 
general management and treatment. The book 
is particularly valuable in that it represents in 
the main the author's own clinical studies, which 
nave been so extensive and fruitful as to give his | 



teachings the stamp of authority all over the 
realm of medicine. The work, although written 
by a specialist, has no exclusive character, and 
the general practitioner above all others will find 
its perusal profitable, since it deals with diseases 
which he frequently encounters and must essay 
to treat.— A merican Practitioner, August, 1885. 



HAMILTON, ALLAJSr McLAJSTE, M. D., 

Attending Physician at the Hospital for Epileptics and Paralytics, BlackweWs Island, N. Y. 
Nervous Diseases ; Their Description and Treatment. Second edition, thoroughly 
revised and rewritten. In one octavo volume of 598 pages, with 72 illustrations. Cloth, $4. 

characterized this book as the best of its kind in 
any language, which is a handsome endorsement 
from an exalted source. The improvements in the 
new edition, and the additions to it, will justify its 
purchase even by those who possess the old.— 
Alienist and Neurologist, April, 1882. 



When the first edition of this good book appeared 
we gave it our emphatic endorsement, and the 

E resent edition enhances our appreciation of the 
ook and its author as a safe guide to students of 
clinical neurology. One of the best and most 
critical of English neurological journals, Brain, has 



TUKE, DANIEL MACK, M. D., 

Joint Author of The Manual of Psychological Medicine, etc. 

Illustrations of the Influence of the Mind upon the Body in Health 
and Disease. Designed to elucidate the Action of the Imagination. New edition. 
Thoroughly revised and rewritten. In one 8vo. vol. of 467 pp., with 2 col. plates. Cloth, $3. 



It is impossible to peruse these interesting chap- 
ters without being convinced of the author's per- 
fect sincerity, impartiality, and thorough mental 
grasp. Dr. Tuke has exhibited the requisite 
amount of scientific address on all occasions, and 
the more intricate the phenomena the more firmly 
has he adhered to a physiological and rational 



method of interpretation. Guided by an enlight- 
ened deduction, the author has reclaimed for 
science a most interesting domain in psychology, 
previously abandoned to charlatans and empirics. 
This book, well conceived and well written, must 
commend itself to every thoughtful understand- 
ing.— New York Medical Journal, September 6, 1884. 



CLOUSTON, THOMAS S., M. D., F. JR. C. P., L. B. C. S., 

Lecturer on Mental Diseases in the University of Edinburgh. 

Clinical Lectures on Mental Diseases. With an Appendix, containing an 
Abstract of the Statutes of the United States and of the Several States and Territories re- 
lating to the Custody of the Insane. By Charles F. Folsom, M. D., Assistant Professor 
of Mental Diseases, Med. Dep. of Harvard Univ. In one handsome octavo volume of 541 
pages, with eight lithographic plates, four of which are beautifully colored. Cloth, $4. 

The practitioner as well as the student will ac- 
cept the plain, practical teaching of the author as a 
forward step in the literature of insanity. It is 
refreshing to find a physician of Dr. Clouston's 
experience and high reputation giving the bed- 
side notes upon which his experience has been 
founded and his mature judgment established. 
Such clinical observations cannot but be useful to 



the general practitioner in guiding him to a diag- 
nosis and indicating the treatment, especially in 
many obscure and doubtful cases of mental dis- 
ease. To the American reader Dr. Folsom's Ap- 
pendix adds greatly to the value of the work, and 
will m uie it a desirable addition to every library. 
— American Psychological Journal, July, 1884. 



gfe^Dr. Folsom's Abstract may also be obtained separately in one octavo volume of 
108 pages. Cloth, $1.50. 

SAVAGE, GEORGE H., M. L>., 

Lecturer on Mental Diseases at Ghuy's Hospital, London. 

Insanity and Allied Neuroses, Practical and Clinical. In one 12mo. vol. 
of 551 pages, with 18 illus. Cloth, $2.00. See Series of Clinical Manuals, page 31. 

JPLATFAIM, W. S., M. JD., F. M. C. F. 

The Systematic Treatment of Nerve Prostration and Hysteria. In 

one handsome small 12mo. volume of 97 pages. Cloth, $1.00. 

Blandford on Insanity and its Treatment: Lectures on the Treatment, 

Medical and Legal, of Insane Patients. In one very nandsome octavo volume. 

Jones' Clinical Observations on Functional Nervous Disorders. 
Second American Edition. In one handsome octavo volume of 340 pages. Cloth, $3.25. 



20 



Lea Brothers & Co.'s Publications — Surgery. 



ASHBTURST, JOSJST, Jr., M. !>., 

Barton Prof, of Surgery and Clin. Surgery in Univ. of Penna., Surgeon to the Penna. Hosp., etc. 

The Principles and Practice of Surgery. New (fifth) edition, enlarged 
and thoroughly revised. In one large and handsome octavo volume of 1144 pages, with 
642 illustrations. Cloth, $6 ; leather, $7. Just ready. 

A complete and most excellent work on surgery. 
It is only necessary to examine it to see at once 
its excellence and real merit either as text-book 
for the student or a guide for the general practi- 



tioner. It fully considers in detail every surgical 
injury and disease to which the body is liable, and 
every advance in surgery worth noting is to be 
found in its proper place. It is unquestionably the 
best and most complete single volume on surgery, 
in the English language, and cannot but receive 
that continued appreciation which its merits justly 
demand. — Southern Practitioner, Feb. 1890. 



This is one of the most popular and useful ot 
the many well-known treatises on general surgery. 
It furnishes in a concise manner a clear and 
comprehensive description of the modes of prac- 
tice now generally employed in the treatment of 
surgical affections, with a plain exposition of the 
principles on which those modes of practice are 
based. The entire work has been carefully revised, 
and a number of new illustrations introduced 
that greatly enhance the value of the book.— 
Cincinnati Lancet-Clinic, Dec. 14, 1889. 



DRUITT, ROBERT, M. R. C. S., etc. 

Manual of Modern Surgery. Twelfth edition, thoroughly revised by Stan- 
ley Boyd, M. B., B. S., F. K. C. S. In one 8vo. volume of 965 pages, with 373 illustra- 



tions. Cloth, $4 ; leather, $5. 

It is essentially a new book, rewritten from be- 
ginning to end. The editor has brought his work 
up to the latest date, and nearly every subject on 
which the student and practitioner would desire 
to consult a surgical volume, has found its place 
here. The volume closes with about twenty pages 
of formula? covering a broad range of practical 
therapeutics. The student will find that the new 
Druitt is to this generation what the old one was 
to the former, and no higher praise need be 
accorded to any volume.— North Carolina Medical 
Journal, October, 1887. 



Druitt's Surgery has been an exceedingly popu- 
lar work in the profession. It is stated that 50,000 
copies have been sold in England, while in the 
United States, ever since its first issue, it has been 
used as a text-book to a very large extent. Dur- 
ing the late war in this country it was so highly 
appreciated that a copy was issued by the Govern- 
ment to each surgeon. The present edition, while 
it has the same features peculiar to the work at 
first, embodies all recent discoveries in surgery, 
and is fully up to the times. Cincinnati Medical 
News, September, 1887. 



GANT, FREDERICK JAMES, F. R. C. S., 

Senior Surgeon to the Royal Free Hospital. 
The Student's Surgery. A Maltum in Parvo. In one square octavo volume 
of 848 pages, with 159 engravings. Cloth, $3.75. 

The claims of this volume to be a multum in 
parvo are certainly substantiated. The author 
covers the whole field of clinical and operative 
surgery in about eight hundred pages of very com- 



pactly printed matter. For a student's manual it 
appears to us in every way excellent, containing 
almost everything necessary to equip the student 
with sound, matter-of-fact knowledge on surgical 



subjects. The volume is a condensation of the 
autnor's well-known larger works on surgery, 
notably his " Science and Practice of Surgery ". 
Students requiring the essentials of surgery 
in a handy and condensed form, and those who 
cannot devote time to theoretical or speculative 
pathology will find this volume exceedingly ser- 
viceable. — The Physician and Surgeon, April, 1890 



ROBERTS, J. B., M. D., 

Professor of Anatomy and Surgery in the Philadelphia Polyclinic. Professor of the Principles and 
Practice of Surgery in the Woman's Medical College of Pennsylvania. 

The Principles and Practice of Modern Surgery. For the use of Students 
and Practitioners of Medicine and Surgery. In one very handsome octavo volume of about 
850 pages, with about 425 illustrations. In press. 

In this volume, as its title indicates, the author has endeavored to give a thorough 
exposition of the best surgical practice of the present time. Not relying on his own 
large experience, he has consulted the latest literature of all kinds bearing on his spec- 
ialty, and has gleaned therefrom the opinions of the best authorities, and the methods of 
the most practical surgeons. The well-established facts of the science are clearly stated, 
but history, theories and untried innovations are rigidly excluded. The work is richly 
illustrated. In the selection of matter and in the consideration of the vast number of 
questions involved, the author has used his most critical judgment in the endeavor to 
render the work of the greatest practical advantage to both practitioners and students. 

GROSS, S. JD., M. L>., LL. D., JD. C. L. Oxon., LL. JD. 
Cantab., 

Emeritus Professor of Surgery in the Jefferson Medical College of Philadelphia. 
A System of Surgery : Pathological, Diagnostic, Therapeutic and Operative. 
Sixth edition, thoroughly revised and greatly improved. In two large and beautifully- 
printed imperial octavo volumes containing 2382 pages, illustrated by 1623 engravings. 
Strongly bound in leather, raised bands, $15. 

BALL, CMARLES B., M. Ch., Dub., F. R. C. S., E., 

Surgeon and Teacher at Sir P. Dun's Hospital, Dublin. 

Diseases of the Rectum and Anus. In one 12mo. volume of 417 pages, 
with 54 engravings and 4 colored plates. Cloth, $2. 25. Just ready. See Series of Clinical 
Manuals, page 31. . 

GIBJSfEY, V. P., M. JD., 



Surgeon to the Orthopaedic Hospital, New York, etc. 
Orthopsedic Surgery. For the use of Practitioners and Students, 
some octavo volume, profusely illustrated. Preparing. 



In one hand- 



Lea Brothers & Co.'s Publications — Surgery. 



21 



ERICHSEN, JOHN E., F. R. S., F. R. C. S., 

Professor of Surgery in University College, London, etc. 
The Science and Art of Surgery; Being a Treatise on Surgical Injuries, Dis- 
eases and Operations. From the eighth and enlarged English edition. In two large and 
beautiful octavo volumes of 2316 pages, illustrated with 984 engravings on wood. 
Cloth, $9; leather, raised bands, $11. 

We have always regarded "The Science and 
Art of Surgery" as one of the best surgical text- 
books in the English language, and this eighth 
edition only confirms our previous opinion. We 
take great pleasure in cordially commending it to 
our readers.— The Medical News, April 11, 1885. 

For many years this classic work has been 
made by preference of teachers the principal 
text-book on surgery for medical students, while 
through translations into the leading continental 
languages it may be said to guide the surgical 
teachings of the civilized world. No excellence 
of the former edition has been dropped and no 
discovery, device or improvement which has 



marked the progress of surgery during the last 
decade has been omitted. The illustrations are 
many and executed in the highest style of art. 
—Louisville Medical News, Feb. 14, 1885. 

We cannot speak too highly of this excellent 
work. It represents the most advanced and settled 
views in regard to the science of surgery, and will 
ever be found a faithful guide and counsellor in 
practice. — Canada Lancet, May, 1885. 

It appears simultaneously in England, America, 
Spain and Italy, and is too well known as a safe 
guide and familiar friend to need further com- 
ment.— New York Medical Journal, March 28, 1885. 



BRYANT, THOMAS, F. R. C. S., 

Surgeon and Lecturer on Surgery at Chuy's Hospital, London. 
The Practice of Surgery. Fourth American from the fourth and revised Eng- 
lish edition. In one large and very handsome imperial octavo volume of 1040 pages, with 
727 illustrations. Cloth, $6.50; leather, $7.50. 
The fourth edition of this work is fully abreast I enable the busy practitioner to review any subject 



of the times. The author handles his subjects 
with that degree of judgment and skill which is 
attained by years of patient toil and varied ex- 
perience. The present edition is a thorough re- 
vision of those which preceded it, with much new 
matter added. His diction is so graceful and 
logical, and his explanations are so lucid, as to 
place the work among the highest order of text- 
books for the medical student. Almost every 
topic in surgery is presented in such a form as to 



in everv-day practice in a short time. No time is 
lost with useless theories or superfluous verbiage. 
In short, the work is eminently clear, logical and 
practical. — Chicago Medical Journal and Examiner, 
April, 1886. 

This book is essentially what it purports to be, 
viz.: a manual for the practice of surgery. It is 
peculiarly well fitted for the student or busy general 
practitioner.— The Medical News, August 15, 1885. 



TREVES, FREDERICK, F. R. C. S., 

Hunterian Professor at the Royal College of Surgeons of England. 
A Manual of Surgery. In Treatises by Various Authors. In three 12mo. 
volumes, containing 1866 pages, with 213 engravings. Price per volume, cloth, $2. See 
Students' Series of Manuals, page 31. 



We have here the opinions of thirty-three 
authors, in an encyclopaedic form for easy and 
ready reference. The three volumes embrace 
every variety of surgical affections likely to be 
met with, the paragraphs are short and pithy, and 



the salient points and the beginnings of new sub- 
jects are always printed in extra-heavy type, so 
that a person may find whatever information he 
may be in need of at a moment's glance. — Cin- 
cinnati Lancet-Clinic, August 21, 1886. 



MARSH, HOWARD, F. R. C. S., 

Senior Assistant Surgeon to and Lecturer on Anatomy at St. Bartholomew's Hospital, London. 
Diseases of the Joints. In one 12mo. volume of 468 pages, with 64 woodcuts 
and a colored plate. Cloth, $2.00. See Series of Clinical Manuals, page 31. 

BTJTLIN, HENRY T., F. R. C. S., 

Assistant Surgeon to St. Bartholomew's Hospital, London. 
Diseases of the Tongue. In one 12mo. volume of 456 pages, with 8 colored 
plates and 3 woodcuts. Cloth, $3.50. See Series of Clinical Manuals, page 31. 

veniently scattered through general works on sur- 



The language of the text is clear and concise. 
The author has aimed to state facts rather than to 
express opinions, and has compressed within the 
compass of this small volume the pathology, etiol- 
ogy, etc., of diseases of the tongue that are incon- 



gery and the practice of medicine. The physician 
and surgeon will appreciate its value as an aid and 
guide.— Physician and Surgeon, Sept. 1886. 



TREVES, FREDERICK, F. R. C. S., 

Surgeon to and Lecturer on Surgery at the London Hospital. 

Intestinal Obstruction. In one pocket-size 12mo. volume of 522 pages, with 60 
illustrations. Limp cloth, blue edges, $2.00. See Series of Clinical Manuals, page 31. 

A standard work on a subject that has not been I justice to the author in a few paragraphs. Intes- 
so comprehensively treated by any contemporary tinal Obstruction is a work that will prove of 
English writer. Its completeness renders a full { equal value to the practitioner, the student, the 
review difficult, since every chapter deserves mi- j pathologist, the physician and the operating sur- 
nute attention, and it is impossible to do thorough | geon. — British Medical Journal, Jan. 31, 1885. 



GOULD, A. FEARCE, M. S., M. B., F. R. C. S„ 

Assistant Surgeon to Middlesex Hospital. 

Elements of Surgical Diagnosis. In one pocket-size 12mo. volume of 589 
pages. Cloth, $2.00. See Students' Series of Manuals, page 31. 

PIRRIE'S PRINCIPLES AND PRACTICE OF one 8vo. vol. of 638 pages, with 340 illustrations. 

SURGERY. Edited by John Neill, M. D. In Cloth, $3.75. 

one8vo.vol. of 784 pp. with 316 illus. Cloth, $3.75. MILLER'S PRACTICE OF SURGERY. Fourth 

MILLER'S PRINCIPLES OF SURGERY. Fourth and revised American edition. In one large 8vo. 

American from the third Edinburgh edition. In vol. of 682 pp., with 364 illustrations. Cloth, $3.75. 



22 Lea Brothers & Co.'s Publications — Surgery, Frac, Disloc. 



SMITH, STEPHEN, M. L>., 

Professor of Clinical Surgery in the University of the City of New York. 

The Principles and Practice of Operative Surgery. New (second) and 
thoroughly revised edition. In one very handsome octavo volume of 892 pages, with 
1005 illustrations. Cloth, $4 00 ; leather, $5.00. 



This excellent and very valuable hook is one. of 
the most satisfactory works on modern operative 
surgery yet published. Its author and publisher 
have spared no pains to make it as far as possible 
an ideal, and their efforts have given it a position 
prominent among the recent works in this depart- 
ment of surgery. The book is a compendium for 
the modern surgeon. The present, the only revised 
edition since 1879, presents many changes from 
the original manual. The volume is much en 
larged, and the text has been thoroughly revised, 
so as to give the most improved methods in asep- 



tic surgery, and the latest instruments known for 
operative work. It can be truly said that as a hand- 
book for the student, a companion for the surgeon, 
and even as a book of reference for the physician 
not especially engaged in the practice of surgery, 
this volume will long hold a most conspicuous 
place, and seldom will its readers, no matter how 
unusual the subject, consult its pages in vain. Its 
compact form, excellent print, numerous illustra- 
tions, and especially its decidedly practical char- 
acter, all combine to commend it.— Boston Medical 
and Surgical Journal, May 10, 1888. 



HOLMES, TIMOTHY, M. A., 

Surgeon and Lecturer on Surgery at St. Georges Hospital, London. 

A Treatise on Surgery ; Its Principles and Practice. New American 
from the fifth English edition, edited by T. Pickering Pick, F. R C. S., Surgeon acd 
Lecturer on Surgery at St. George's Hospital, London. In one octavo volume of 997 
pages, with 428 illustrations. Cloth, $6; leather, $7. Just ready. 



To the younger members of the profession and 
to others not acquainted with the book and its 
merits, we take pleasure in recommending it as a 
surgery complete, thorough, well-written, fully 
illustrated, modern, a work sufficiently volumi- 
nous for the surgeon specialist, adequately concise 



for the general practitioner, teaching those things 
that are necessary to be known for the successful 
pro ecution of the physician's career, imparting 
nothing that in our present knowledge is consid- 
ered unsafe, unscientific or inexpedient.— Pacific 
Medical Journal, July, 1889. 



HOLMES, TIMOTHY, M. A., 

Surgeon and Lecturer on Surgery at St. George's Hospital, London. 

A System of Surgery ; Theoretical and Practical. 



IN TREATISES BY 



VARIOUS AUTHORS. American edition, thoroughly revised and re-edited 
by John H. Packard, M. D., Surgeon to the Episcopal and St. Joseph's Hospitals, 
Philadelphia, assisted by a corps of thirty-three of the most eminent American surgeons. 
In three large imperial octavo volumes containing 3137 double- coiumned pages, with 
979 illustrations on wood and 13 lithographic plates, beautifully colored. Price per 
set, cloth, $18.00 ; leather, $21.00. Sold only by subscription. 

STIMSOJST, LEWIS A., B. A., M. D., 

Surgeon to the Presbyterian and Bellevue Hospitals, Professor of Clinical Surgery in the Medical 
Faculty of Univ. of City of N. Y., Corresponding Member of the Societe de Chirurgie of Paris. 
A Manual of Operative Surgery. New (second) edition. In one very hand- 
some royal 12mo. volume of 503 pages, with 342 illustrations. Cloth, $2.50. 



There is always room for a good book, so that 
while many works on operative surgery must be 
considered superfluous, that of Dr. Stimson has 
held its own. The author knows the difficult art 
of condensation. Thus the manual serves as a 
work of reference, and at the same time as a 
handy guide. It teaches what it professes, the 
steps of operations. In this edition Dr. Stimson 
has sought to indicate the changes that have been 



effected in operative methods and procedures by 
the antiseptic system, and has added an account 
of many new operations and variations in the 
steps of older operations. We do not desire to 
extol this manual above many excellent standard 
British publications of the same class, still we be- 
lieve that it contains much that is worthy of imi- 
tation. — British Medical Journal, Jan. 22, 1887. 



By the same Author. 
A Treatise on Fractures and Dislocations. In two handsome octavo vol- 
umes. Vol. I., Fractures, 582 pages, 360 beautiful illustrations. Vol. II., Disloca- 
tions, 540 pages, with 163 illustrations. Complete work, cloth, $5.50 ; leather, $7.50. 
Either volume separately, cloth, $3.00; leather, $4.00. 



The appearance of the second volume marks the 
completion of the author's original plan of prepar- 
ing a work which should present in the fullest 
manner all that is known on the cognate subjects 
of Fractures and Dislocations. The volume on 
Fractures assumed at once the position of authority 
on the subject, and its companion on Dislocations 
will no doubt be similarly received. The closing 
volume of Dr. Stimson's work exhibits the surgery 



of Dislocations as it is taught and practised by the 
most eminent surgeons of the present time. Con- 
taining the results of such extended researches it 
must for a long time be regarded as an authority 
on all subjects pertaining to dislocations. Every 
practitioner of surgery will feel it incumbent on 
him to have it for constant reference. — Cincinnati 
Medical News, May, 1888. 



HAMILTON, EBAJVH H., M. !>., LL. Z>. 9 

Surgeon to Bellevue Hospital, New York. 

A Practical Treatise on Fractures and Dislocations. Seventh edition 
thoroughly revised and much improved. In one very handsome octavo volume of 998 
pages, with 379 illustrations. Cloth, $5.50 ; leather, $6.50. 

This hook is without a rival in any language. It 
is essentially a practical treatise, and it gathers 
within its covers almost everything valuable that 
has been written about fractures and dislocations. 
The principles and methods of treatment are very 



fully given. The book is so well known that it does 
not require any lengthened review. We can only 
say that it is still unapproached as a treatise. — 
The Dublin Journal of Medical Science, Feb. 1886. 



PICK, T PICKETING, F. K. C. S., 

Surgeon to and Lecturer on Surgery at St. George's Hospital, London. 

Fractures and Dislocations. In one 12mo. volume of 530 pages, 
illustrations. Limp cloth, $2.00. See Series of Clinical Manuals, page 31. 



with 93 



Lea Brothers & Co.'s Publications — Otol., Ophtlial. 



2a 



BVBNETT, CHARLES H., A. M., M. JD., 

Professor of Otology in the Philadelphia Polyclinic ; President of the American Otological Society. 

The Ear, Its Anatomy, Physiology and Diseases. A Practical Treatise 
for the use of Medical Students and Practitioners. Second edition. In one handsome 
octavo volume of 580 pages, with 107 illustrations. Cloth, $4.00 ; leather, $5.00. 

We note with pleasure the appearance of a second 
edition of this valuable work. When it first came 
out it was accepted by the profession as one of 
the standard works on modern aural surgery in 
the English language; and in his second edition 
Dr. Burnett has fully maintained his reputation. 



for the book is replete with valuable information 
and suggestions. The revision has been carefully 



carried out, and much new matter added. Dr. 
Burnett's work must be regarded as a very valua- 
ble contribution to aural surgery, not only on 
account of its comprehensiveness, but because it 
contains the results of the careful personal observa- 
tion and experience of this eminent aural surgeon. 
—London Lancet, Feb. 21, 1885. 



jpolitzeb, An am, 

Imperial- Royal Prof, of Aural Therap. in the Univ. of Vienna. 
A Text-Book of the Ear and its Diseases. Translated, at the Author's re- 
quest, by James Patterson Cassells, M. D., M. E. C. S. In one handsome octavo vol- 
ume of 800 pages, with 257 original illustrations. Cloth, $5.50. 

The whole work can be recommended as a reli- I the practitioner in his treatment.— Boston Medical 
able guide to the student, and an efficient aid to | and Surgical Journal, June 7, 1883. 



BEBBY, GEOBGE A., M. B., F. B. C. S., Ed., 

Ophthalmic Surgeon, Edinburgh Royal Infirmary. 

Diseases of the Eye. A Practical Treatise for Students of Ophthalmology. Id 
one octavo volume of 683 pages, with 144 illustrations, 62 of which are beautifully 
colored. Cloth, $7.50. 



This newest candidate for favor among opbthal- 
mological students is designed to be purely clinical 
in character and the plan is well adhered to. We 
have been forcibly struck by the rare good taste 
in the selection of what is essential which per- 
vades the book. The author seems to have the 
uncommon faculty of viewing his subject as a 
whole and seizing the salient points and not con- 
fusing his reader — presumably a student and a 



novice — with a mass of details with no key to their 
unravelling. It is apparent that the literature of 
each subject has been gone over in a very thor- 
ough manner. The fact that he was writing a 
clinical treatise for beginners and not an encyclo- 
paedia has always been present with the author. 
The number and excellence of the colored illus- 
trations in the text deserve more than a passing 
notice.— Archives of Ophthalmology, Sept. 1889. 



JTJLEB, JELEWBY E., F. B. C. S., 

Senior Ass't Surgeon, Royal Westminster Ophthalmic Hosp. ; late Clinical Ass't, Moorfields, London. 

A Handbook of Ophthalmic Science and Practice. Handsome 870. vol- 
ume of 460 pages, with 125 woodcuts, 27 colored plates, selections from Test-types of 
Jaeger and Snellen, and Holmgren's Color-blindness Test. Cloth, $4.50 ; leather, $5.50. 
It presents to the student concise descriptions illustrations are nearly all original. We have ex- 
and typical illustrations of all important eye affec- amined this entire work with great care, and it 
tions, placed in juxtaposition, so as to be grasped represents the commonly accepted views of ad- 
at a glance. Beyond a doubt it is the best illus- vanced ophthalmologists. We can most heartily 
trated handbook of ophthalmic science which has commend this book to all medical students, prac- 
ever appeared. Then, what is still better, these titioners and specialists. — Detroit Lancet, Jan. '85. 



NETTLESBJIJP, EJDWABJD, F. B. C. &, 

Ophthalmic Surg, and Led. on Ophth. Surg, at St. Thomas' Hospital, London. 

The Student's Guide to Diseases of the Eye. New (third) edition, thor- 
oughly revised. With a chapter on the Detection of Color-Blindness, by William 
Thomson, M. D., Professor of Ophthalmology in the Jefferson Medical College. In one 
12mo. volume of 479 pages, with 164 illust., test-types and formulae. Cloth, $2. 

The extent of the sale of this now accepted 
authority has conclusively shown that its claim for 
favor was not an imaginary one. The introductory 
chapter on optical outlines is a wonderfully clear 
statement of the principles involved. The writer's 
decision of character has fully impressed his pro- 
duction, and this is nowhere more apparent than 



in the chapter devoted to operations. A very 
important part of the work to general practitioners 
is that embraced in the consideration of eye dis- 
eases in relation to general diseases and condi- 
tions. The arrangement of the remedies employed 
into a formulary is adopted, and it contains much 
useful knowledge.— South. Practitioner, Dec. 1887. 



FOBBIS, WM. F., M. JD., and OLIVEB, CJSAS. A., M. JD. 

Clin. Prof, of Ophthalmology in Univ. of Pa. 

A Text-Book of Ophthalmology. In one octavo volume of about 500 pages, 
with illustrations. Preparing. 



CABTEB, B. BBUJDENELL, & FBOST, W.ADAMS, 

F. B. C. S., F. B. C. S., 

Ophthalmic Surgeon to and Led. on Ophthal- Ass't Ophthalmic Surgeon and Joint Led. 

mic Surgery at St. George's Hospital, London. on Oph. Sur., St. George's Hosp., London. 

Ophthalmic Surgery. In one 12mo. volume of 559 pages, with 91 woodcuts, 
color blindness test, test-types and dots and appendix of formulae, Cloth, $2.25. See 
Series of Clinical Manuals, page 31. 



WELLS ON THE EYE. In one octavo volume. 

LAURENCE AND MOON'S HANDY BOOK OF 
OPHTHALMIC SURGERY, for the use of Prac- 
titioners. Second edition. In one octavo vol- 
ume of 227 pages, with 65 illus. Cloth, $2.75. 



LAWSON ON INJURIES TO THE EYE, ORBIT 
AND EYELIDS: Their Immediate and Remote 
Effects. In one octavo volume of 404 pages, with 
92 illustrations. Cloth, $3.50. 



24 Lea Brothers & Co.'s Publications — Urin. Dis., Dentistry, etc. 



BOBEBTS, WILLIAM, M. D., 

Lecturer on Medicine in the Manchester School of Medicine, etc. 

A Practical Treatise on Urinary and Renal Diseases, including Uri- 
nary Deposits. Fourth American from the fourth London edition. In one hand- 
some octavo volume of 609 pages, with 81 illustrations. Cloth, $3.50. 

It may be said to be the best book in print on the ] guage in its account of the different affections. — 
subject of which it treats. — The American Journal < The Manchester Medical Chronicle, July, 1885. 
of the Medical Sciences, Jan. 1886. The value of this treatise as a guide book to the 

The peculiar value and finish of the book are in j physician in daily practice can hardly be over- 
a measure derived from its resolute maintenance j estimated. That it is fully up to the level of our 
of a clinical and practical character. It is an un- I present knowledge is a fact reflecting great credit 
rivalled exposition of everything which relates | upon Dr. Roberts, who has a wide reputation as a 
directly or indirectly to the diagnosis, prognosis busy practitioner.— The Medical Record, July 31, 
and treatment of urinary diseases, and possesses 1886. 
a completeness not found elsewhere in our Ian- 



BUBDY, CSABLES W., M. D. 9 Chicago. 

Bright's Disease and Allied Affections of the Kidneys. 

volume of 288 pages, with illustrations. Cloth, $2. 



In one octavo 



The object of this work is to "furnish a system 
atic, practical and concise description of the 

Sathology and treatment of the chief organic 
iseases of the kidney associated with albuminu- 
ria, which shall represent the most recent ad- 
vances in our knowledge on these subjects ; " and 
this definition of the object is a fair description of 
the book. The work is a useful one, giving in a 



short space the theories, facts and treatments, and 
going more fully into their later developments. 
On treatment the writer is particularly strong, 
steering clear of generalities, and seldom omit- 
ting, what text-books usually do, the unimportant 
items which are all important to the general prac- 
titioner. — The Manchester Medical Chronicle, Oct. 
1886. 



MOBBIS, HENBY, M. B., F. B. C. S., 

Surgeon to and Lecturer on Surgery at Middlesex Hospital, London. 

Surgical Diseases of the Kidney. In one 12mo. volume of 554 pages, with 40 
woodcuts, and 6 colored plates. Limp cloth, $2.25. See Series of Clinical Manuals, page 31. 

In this manual we have a distinct addition to 
surgical literature, which gives information not 
elsewhere to be met with in a single work. Such 
a book was distinctly required, and Mr. Morris 
has very diligently and ably performed the task 



he took in hand. It is a full and trustworthy 
book of reference, both for students and prac- 
titioners in search of guidance. The illustrations 
in the text and the chromo-lithographs are beau- 
tifully executed. — The London Lancet,Feb. 26, 1886. 



See Series 



LUCAS, CLEMENT, M. B., B. S., E. B. C. S., 

Senior Assistant Surgeon to Guy's Hospital, London. 
Diseases of the Urethra. In one 12mo. volume. Preparing, 
of Clinical Manuals, page 4. 

THOMPSON, SIB HEJSIBY, ~~ 

Surgeon and Professor of Clinical Surgery to University College Hospital, London. 

Lectures on Diseases of the Urinary Organs. Second American from the 
third English edition. In one 8vo. volume of 203 pp., with 25 illustrations. Cloth, $2.25. 

By the Same Author. 
On the Pathology and Treatment of Stricture of the Urethra and 
Urinary Fistulse. From the third English edition. In one octavo volume of 359 
pages, with 47 cuts and 3 plates. Cloth, $3.50. 

TELE AMEBICAJST SYSTEM OF DEKTISTBY. 

In Treatises by Various Authors. Edited by Wilbur F. Litch, M. D., 
D. D. S., Professor of Prosthetic Dentistry, Materia Medica and Therapeutics in the 
Pennsylvania College of Dental Surgery. In three very handsome octavo volumes con- 
taining 3160 pages, with 1863 illustrations and 9 full page plates. Per volume, cloth, $6 ; 
leather, $7 ; half Morocco, gilt top, $8. The complete work is now ready. For sale by 
subscription only. 



As an encyclopaedia of Dentistry it has no su- 

fierior. It should form a part of every dentist's 
ibrary, as the information it contains is of the 
freatest value to all engaged in the practice of 
entistry. — American Jour. Dent. Sci., Sept. 1886. 
A grand system, big enough and good enough 
and handsome enough for a monument (which 



doubtless it is), to mark an epoch in the history of 
dentistry. Dentists will be satisfied with it and 
proud of it — they must. It is sure to be precisely 
what the student needs to put him aad keep him 
in the right track, while the profession at large 
will receive incalculable benefit from it. — Odonto- 
graphy Journal, Jan. 1887. 



COLEMAJV, A., L. B. C. P., F. B. C. 8., Exam. L. D. S. 9 

Senior Bent. Surg, and Led. on Dent. Surg, at St. Bartholomew's Hosp. and the Dent. Hosp., London. 

A Manual of Dental Surgery and Pathology. Thoroughly revised and 
adapted to the use of American Students, by Thomas C. Stellwagen, M. A., M. D., 
D. D. S., Prof, of Physiology in the Philadelphia Dental College. In one handsome octavo 
volume of 412 pages, with 331 illustrations. Cloth, $3.25. 



It should be in the possession of every practi- 
tioner in this country. The part devoted to first 
and second dentition and irregularities in th6 per- 
manent teeth is fully worth the price. In iact, 
price should not be considered in purchasing such 
a work. If the money put into some of our so- 
called standard text-books could be converted into 
such publications as this, much good would result. 
— Southern Dental Journal, May, 1882. 



The author brings to his task a large experience 
acquired under the most favorable circumstances. 
There have been added to the volume a hundred 
pages by the American editor, embodying the 
views of the leading home teachers in dental sur- 
gery. The work, therefore, may be regarded as 
strictly abreast of the times, and as a very high 
authority on the subjects of which it treats. — 
American Practitioner, July, 1882. 



BASHAM ON RENAL DISEASES : A Clinical 
Guide to their Diagnosis and Treatment. In 



one 12mo. vol. of 304 pages, with 21 illustrations. 
Cloth, $2.00. 



Lea Brothers & Co.'s Publications — Venereal, Impotence. 25 

GBOSS, SAMUEL W., A. M., M. JD., LL. JD., 

Professor of the Principles of Surgery and of Clinical Surgery in the Jefferson Medical College of Phila. 

A Practical Treatise on Impotence, Sterility, and Allied Disorders 
of the Male Sexual Organs. New (4th) edition, thoroughly revised by F. B. 
Sturgis, M. D., Prof, of Diseases of the Genito-Urinary Organs and of Venereal Diseases, 
N. Y. Post Grad. Med. School. In one very handsome octavo volume of about 175 
pages, with about 20 illustrations. Preparing. 

A few notices of the previous edition are appended. 
It must be gratifying to both author and pub- ' This now classical work on the subject of impo- 
lishers that large first and second editions of this tence and sterility in the male needs no extended 
little work were so soon exhausted, while the fact review, for it is already well known to the pro- 
that it has been translated into Russian may indi- fession. Dr. Gross has by his tireless labor done 
cate that it filled a void even in foreign literature, more towards clearing up the diagnosis and treat- 
His is a careful and physiological study of the mentof these obscure cases than any other Ameri- 
sexual act, so far as concerns the male, and all can physician. The fact that this book has rapidly 
his conclusions are scientifically reached. The run through two large editions, and that the author 
book has a place by itself in our literature, and • is now forced to issue a third, is good and sufficient 
furnishes a large fund of information concerning ; evidence of its excellence.— Atlanta Medical and 
important matters that are too often passed over ! Surgical Journal, April, 1888. 
in silence.— The Medical Press, June, 1887. 



TAYLOB, B. W., A. M., M. I)., 

Surgeon to Charity Hospital, New York, Prof, of Venereal and Skin Diseases in the University of 
Vermont, Pres. of the Am. Dermatological Ass'n. 

The Pathology and Treatment of Venereal Diseases. Including the 
results of recent investigations upon the subject. Being the sixth edition of Bumstead 
and Taylor. Entirely rewritten by Dr. Taylor. Large 8vo. volume, about 900 pages, 
with about 150 engravings, as well as numerous chromo-lithographs. Preparing. 
A few notices of the previous edition are appended. 

It is a splendid record of honest labor, wide j known that it would be superfluous here to pass in 
research, just comparison, careful scrutiny and I review its general or special points of excellence, 
original experience, which will always be held as j The verdict of the profession has been passed; it 
a high credit to American medical literature. This ! has been accepted as the most thorough and corn- 
is not only the best work in the English language i plete exposition of the pathology and treatment of 
upon the subjects of which it treats, but also one venereal diseases in the language. Admirable as a 
which has no equal in other tongues for its clear, j model of clear description, an exponent of sound 
comprehensive and practical handling of its ! pathological doctrine, and a guide for rational and 
themes. — Am. Jour, of the Med. Sciences, Jan, 1884. successful treatment, it is an ornament to the medi- 

It is certainly the best single treatise on vene- cal literature of this country. The additions made 
real in our own, and probably the best in any Ian- [ to the present edition are eminently judicious,, 
guage. — Boston Med. and Surg. Journal, April 3, 1884. j from the standpoint of practical utility. — Journal of 

The character of this standard work is so well | Cutaneous and Venereal Diseases, Jan. 1884. 



COBNIL, V. 9 

Professor to the Faculty of Medicine of Paris, and Physician to the Lour cine Hospital. 

Syphilis, its Morbid Anatomy, Diagnosis and Treatment. Specially 
revised by the Author, and translated with notes and additions by J. Henry C. Simes, 
M. D., Demonstrator of Pathological Histology in the Univ. of Pa., and J. William 
White, M. D., Lecturer on Venereal Diseases, Univ. of Pa. In one handsome octavo 
volume of 461 pages, with 84 very beautiful illustrations. Cloth, $3.75. 

The anatomy, the histology, the pathology and | perusal without the feeling that his grasp of the 
the clinical features of syphilis are represented in | wide and important subject on which it treats is- 
this work in their best, most practical and most a stronger and surer one. — The London Practi- 
instructive form, and no one will rise from its | tioner, Jan. 1882. 

HUTCHINSON, JONATHAN, F. B. S., F. B. C. S., 

Consulting Surgeon to the London Hospital. 

Syphilis. In one 12mo. volume of 542 pages, with 8 chromo-lithographs. Cloth,. 
$2.25. See Series of Clinical Manuals, page 31. 

Those who have seen most of the disease and I and power of observation, but of his patience and 
those who have felt the real difficulties of diagno- assiduity in taking notes of his cases and keep- 
sis and treatment will most highly appreciate the ing them in a form available for such excellent 
facts and suggestions which abound in these use as he has put them to in this volume.— London 
pages. It is a worthy and valuable record, not ' Medical Record, Nov. 12, 1887. 
only of Mr. Hutchinson's very large experience | 

GBOSS, S. D., M. JO., LL. I)., JO. C. L„ etc. 

A Practical Treatise on the Diseases, Injuries and Malformations 
of the Urinary Bladder, the Prostate Gland and the Urethra. Third 
edition, thoroughly revised by Samuel W. Gross, M. D. In one octavo volume of 574 
pages, with 170 illustrations. Cloth, $4.50. 

CULLJEBIFB, A., & BUMSTEAD, F. J., M.I)., LL.D., 

Surgeon to the Hopital du Midi. Late Professor of Venereal Diseases in the College of Physicians 

and Surgeons, New York. 

An Atlas of Venereal Diseases. Translated and edited by Freeman J. Bum- 
stead, M. D. In one imperial 4to. volume of 328 pages, double-columns, with 26 plates, 
containing about 150 figures, beautifully colored, many of them the size of life. Strongly 
bound in cloth, $17.00. A specimen of the plates and text sent by mail, on receipt of 25 cts. 

HILL ON SYPHILIS AND LOCAL CONTAGIOUS FORMS OF LOCAL DISEASE AFFECTING- 
DISORDERS. In one 8vo vol. of 479 p. Cloth, $3.25. PRINCIPALLY THE ORGANS OF GENERA- 
LEE'S LECTURES ON SYPHILIS AND SOME | TION. In one 8vo. vol. of 246 pages. Cloth, $2.25, 



26 



Lea Brothers & Co.'s Publications — Venereal, Skin. 



TAYLOR, ROBERT W., A.M., M.D., 

Surgeon to Charity Hospital, New York, and to the Department of Venereal and Skin Diseases oj 
the New Fork Hospital. 

A Clinical Atlas of Venereal and Skin Diseases: Including Diagnosis, 
Prognosis and Treatment. In eight large folio parts, measuring 14 x 18 inches, and 
comprising 58 beautifully-colored plates with 213 figures, and 431 pages of text with 85 
engravings. Complete work just ready. Price per part, $2.50. Bound in one volume, 
half Kussia, $27 ; half Turkey Morocco, $28. For sale by subscription only. Specimen 
plates sent on receipt of 10 cents. A full prospectus sent to any address on application. 

allotted to a notice of this kind, and while we 



The completion of this monumental work is a 
subject of congratulation, not only to the author 
and publishers, but to the profession at large ; 
indeed it is to the latter that it directly appeals as 
a wonderfully clear exposition of a confessedly 
difficult branch of medicine Good literature has 
joined hands with good art with highly satisfac- 
tory results for both. There are altogether 213 
figures, many of which are life size, and represent 
the highest perfection of the chromo- litho- 
graphic art, and scattered throughout the text are 
innumerable engravings. Quite a proportion of 
these illustrations are from the author's own 
collection, while on the other hand the best 
atlases of the world have been drawn upon for 
the most typical and successful pictures of the 
many different types of venereal and skin dis 
ease. We think we may say without undue 
exaggeration that the reproductions, both in color 
and in black and white, are almost invariably 
successful. The text is practical, full of thera- 
peutical suggestions, and the clinical accounts of 
disease are clear and incisive. Dr. Taylor is, 
happily, an eminent authority in both departments, 
And we find as a consequence that the two divis- 
ions of this work possess an equal scientific and 
literary merit. We have already passed the limits 



have nothing but praise for this admirable atlas, 
it must be said in justification that it is more than 
warranted by the merits of the work itself. — 
The Medical News, Dec. 14, 1889. 

It would be hard to use words which would per- 
spicuously enough convey to the reader the great 
value of this Clinical Atlas. This Atlas is more 
complete even than an ordinary course of clinical 
lectures, for in no one college or hospital course 
is it at all probable that all of the diseases herein 
represented would be seen. It is also more ser- 
viceable to the majority of students than attend- 
ance upon clinical lectures, for most of the 
students who sit on remote seals in the lecture 
hall cannot see the subject as well as the office 
student can examine these true to-life chromo-lith- 
ographs. Comparing the text to a lecturer, it is 
more satisfactory in exactness and fulness than 
he would be likely to be in lecturing over a single 
case. Indeed, this Atlas is invaluable to the gen- 
eral practitioner, for it enables the eye of the 
physician to make diagnosis of a given case of 
skin manifestation by comparing the case with 
the picture in the Atlas, where will be found also 
the text of diagnosis, pathology, and full sections 
on treatment.— Virginia Medical Monthly, Dec, 1889. 



HYJDE, J. NEVINS, A. M., M. D., 

Professor of Dermatology and Venereal Diseases in Rush Medical College, Chicago. 

A Practical Treatise on Diseases of the Skin. For the use of Students and 
Practitioners. New (second) edition. In one handsome octavo volume of 676 pages, 
with 2 colored plates and 85 beautiful and elaborate illustrations. Cloth, $4.50; leather, $5.50. 

The second edition of his treatise is like his 



We can heartily commend it, not only as an 
admirable text-book for teacher and student, but 
in its clear and comprehensive rules for diagnosis, 
its sound and independent doctrines in pathology, 
and its minute and judicious directions for the 
treatment of disease, as a most satisfactory and 
complete practical guide for the physician. — Ameri- 
can Journal of the Medical Sciences, July, 1888. 

A useful glossary descriptive of terms is given. 
The descriptive portions of this work are plain 
and easily understood, and above all are very 
accurate. The therapeutical part is abundantly 
supplied with excellent recommendations. The 
picture part is well done. The value of the work 
to practitioners is great because of the excellence 
of the descriptions, the suggestiveness of the 
advice, and the correctness of the details and the 
principles of therapeutics impressed upon the 
reader. — Virginia Med. Monthly, May, 1888. 



clinical instruction, admirably arranged, attractive 
in diction, and strikingly practical throughout. 
The chapter on general symptomatology is a model 
in its way ; no clearer description of the various 
primary and consecutive lesions of the skin is to 
be met with anywhere. Those on general diagno- 
sis and therapeutics are also worthy of careful 
study. Dr. Hyde has shown himself a compre- 
hensive reader of the latest literature, and has in- 
corporated into his book all the best of that which 
the past years have brought forth. The prescrip- 
tions and formulae are given in both common and 
metric systems. Text and illustrations are good, 
and colored plates of rare cases lend additional 
attractions. Altogether it is a work exactly fitted 
to the needs of a general practitioner, and no one 
will make a mistake in purchasing it. — Medical 
Press of Western New York, June, 1888. 



FOX, T., M. JD., F.R. C. P., and FOX, T. C, B.A., M.R. C.S., 

Physician to the Department for Skin Diseases, Physician for Diseases of the Skin to the 

University College Hospital, London. Westminster Hospital, London. 

An Epitome of Skin Diseases. With Formulae. For Students and Prac- 
titioners. Third edition, revised and enlarged. In one very handsome 12mo. volume 
of 238 pages. Cloth, $1.25. 



The third edition of this convenient handbook 
oalls for notice owing to the revision and expansion 
which it has undergone. The arrangement of skin 
diseases in alphabetical order, which is the method 
of classification adopted in this work, becomes a 
positive advantage to the student. The book is 
one which we can strongly recommend, not only 
to students but also to practitioners who require a 
compendious summary of the present state of 
dermatology. — British Medical Journal, July 2, 1883. 

We cordially recommend Fox's Epitome to those 
whose time is limited and who wish a handy 



manual to lie upon the table for instant reference. 
Its alphabetical arrangement is suited to this use, 
for all one has to know is the name of the disease, 
and here are its description and the appropriate 
treatment at hand and ready for instant applica- 
tion. The present edition has been very carefully 
revised and a number of new diseases are de- 
scribed, while most of the recent additions to 
dermal therapeutics find mention, and the formu- 
lary at the end of the book has been considerably 
augmented.— The Medical News, December, 1883. 



WILSOJV, ERASMUS, F. R. S. 

The Student's Book of Cutaneous Medicine and Diseases of the Skin. 

In one handsome small octavo volume of 535 pages. Cloth, $3.50. 



flILLIER'S HANDBOOK OF SKIN DISEASES; 
for Students and Practitioners. Second Ameri- 



can edition, 
with plates. 



In one 12mo. volume of 353 pages, 
Cloth, $2.25. 



Lea Brothers & Co.'s Publications — Dis. of Women, 



27 



The American Systems of Gynecology and Obstetrics. 

Systems of Gynecology and Obstetrics, in Treatises by American 
Authors. Gynecology edited by Matthew D. Mann, A. M., M. D., Professor of Obstetrics 
and Gynecology in the Medical Department of the University of Buffalo; and Obstet- 
rics edited by Barton Cooke Hirst, M. D., Associate Professor of Obstetrics in the 
University of Pennsylvania, Philadelphia. In four very handsome octavo volumes, con- 
taining 3612 pages, 1092 engravings and 8 plates. Complete work just ready. Per vol- 
ume: Cloth, $5.0C; leather, $6.00; half Russia, $7.00. For sale by subscription only. 
Address the Publishers. Full descriptive circular free on application. 

LIST OF CONTRIBUTORS. 



WILLIAM H. BAKER, M. L\, 
ROBERT BATTEY, M. D., 
SAMUEL C. BUSEY, M. D., 
JAMES C. CAMERON, M. D., 
HENRY C. COE, A. M., M. D., 
EDWARD P. DAVIS, M. D., 
G E. De SCHWEINITZ, M. D., 
E. C. DUDLEY, A. B., M. D., 
B. McE. EMMET, M. D., 
GEORGE J. ENGELMANN, M. D., 
HENRY J. GARRIGUES, A. M., M. D., 
WILLIAM GOODELL, A. M., M. D., 
EGBERT H. GRANDIN, A. M., M. D., 
SAMUEL W. GROSS, M. D., 
ROBERT P. HARRIS, M. D., 
GEORGE T. HARRISON, M. D., 
BARTON C. HIRST, M. D. 
STEPHEN Y. HOWELL, M. D., 
A. REEVES JACKSON, A. M., M. D., 
W. W. JAGGARD, M. D., 
EDWARD W. JENKS, M. D., LL. D., 
HOWARD A. KELLY, M. D., 
This is volume two of The American System of 
Obstetrics, completing the wonderfully full series 
issued from the house of Lea Brothers & Co. dur- 
ing the past two years. Two magnificent volumes 
devoted to gynecology, and now two like volumes 
embracing everything pertaining to obstetrics. 
These volumes are the contributions of the most 
eminent gentlemen of this country in these de- 
partments of the profession. Each contributor 
presents a monograph upon his special topic, 
apparently without restriction in space, so that 
everything in the way of history, theory, methods, 
and results is presented to our fullest need. The 
work will long remain as a monument of great in- 
dustry and good judgment. As a work of general 
reference, it will be found remarkably full and in- 
structive in every direction of inquiry.— The Ob- 
stetric Gazette, September, 1889. 

There can be but little doubt that this work will 
find the same favor with the profession that has 
been accorded to the "System of Medicine by 
American Authors," and the "System of Gynecol- 
ogy byAmerican Authors." One is at a loss to know 
what to say of this volume, for fear that just and 
merited praise may be mistaken for flattery. The 
subjects of some of the papers are discussed in 
various works on obstetrics, though not to the full 



CHARLES CARROLL LEE, M. D., 
WILLIAM T. LUSK, M. D., LL. D., 
J. HENDRIE LLOYD, M. D , 
MATTHEW D. MANN, A. M., M. D., 
H. NEWELL MARTIN, F. R. S., M. D.» 

D.Sc, M.A., 
RICHARD B. MAURY, M. D., 
C. D. PALMER, M. D., 
ROSWELL PARK, M. D., 
THEOPHILUS PARVIN, M. D., LL. D., 
R. A. F. PENROSE, M. D., LL. D., 
THADDEUS A. REAMY, A. M., M. D., 
J. C. REEVE, M. D., 
A. D. ROCKWELL, A. M., M. D., 
ALEXANDER J. C. SKENE, M. D., 
J. LEWIS SMITH, M. D., 
STEPHEN SMITH, M. D., 
R. STANSBURY SUTTON, A. M., M. D ., 

LL. D., 
T. GAILLARD THOMAS, M. D., LL. D., 
ELY VAN DE WARKER, M. D., 
W. GILL WYLIE, M. D. 
tor may be congratulated for having made such a 
wise selection of his contributors. — Journal of the 
American Medical Association, Sept. 8, 1888. 

In our notice of the "System of Practical Medi- 
cine by American Authors," we made the follow- 
ing statement:— "It is a work of which the pro- 
fession in this country can feel proud. Written 
exclusively by American physicians who are ac- 
quainted with all the varieties of climate in the 
United. States, the character of the soil, the man- 
ners and customs of the people, etc., it is pecul- 
iarly adapted to the wants of American practition- 
ers of medicine, and it seems to us that every one 
of them would desire to have it." Every word 
thus expressed in regard to the "American Sys- 
tem of Practical Medicine" is applicable to the 
"System of Gynecology by American Authors," 
which we desire now to bring to the attention of 
our readers. It, like the other, has been written 
exclusively by American physicians who are 
acquainted with all the characteristics of American 
people, who are well informed in regard to the 
peculiarities of American women, their manners, 
customs, modes of living, etc. As every practis- 
ing physician is called upon to treat diseases of 
females, and as they constitute a class to which 
the family physician must give attention, and 



extent that is found in this volume. The papers : cannot pass over to a specialist, we do not know of 



of Drs. Engelmann, Martin, Hirst, Jaggard am 
Reeve are incomparably beyond anything that can 
be found in obstetrical works. Certainly the Edi- 



a work in any department of medicine that we 
should so strongly recommend medical men gen- 
erally purchasing.— Cincinnati Med. News, July,1887. 



TMOMAS, T. GAILLAItn, M. !>., LL. L>., 

Professor of Diseases of Women in the College of Physicians and Surgeons, N. Y. 

m A Practical Treatise on the Diseases of Women. Fifth edition, thoroughly 
revised and rewritten. In one large and handsome octavo volume of 810 pages, with 26& 
illustrations. Cloth, $5.00 ; leather, $6.00. 



That the previous editions of the treatise of Dr. 
Thomas were thought worthy of translation into 
German, French, Italian and Spanish, is enough 
to give it the stamp of genuine merit. At home it 
has made its way into the library of every obste- 



trician and gynaecologist as a safe guide to practice. 
No small number of additions have been made to 
the present edition to make it correspond to re- 
cent improvements in treatment. — Pacific Medical 
and Surgical Journal, Jan. 1881. 



JEDIS, AMTJLUK W. 9 M. L>., Lond., F.B. C.P., M.B. C.S., 

Assist. Obstetric Physi cian to Middlesex Hospital, late Physician to British Lying-in Hospital. 
The Diseases Of Women. Including their Pathology, Causation, Symptoms, 
Diagnosis and Treatment. A Manual for Students and Practitioners. In one handsome 
octavo volume of 576 pages, with 148 illustrations. Cloth, $3.00 ; leather, $4.00. 

It is a pleasure to read a book so thoroughly are among the more common methods of treat- 
good as this one. The special qualities which are ment, and yet very little is said about them in 
conspicuous are thoroughness in covering the many of the text-books. The book is one to be 
whole ground, clearness of description and con- warmly recommended especially to students and 
ciseness of statement. Another marked feature of i general practitioners, who need a concise but com- 
the book is the attention paid to the details of: plete resumi of the whole subject. Specialists, too, 
many minor surgical operations and procedures, will find many useful hints in its pages.— Boston 
as, for instance, the use of tents, application of j Med. and Surg. Journ., March 2, 1882. 
leeches, and use of hot water injections. These | 



28 



Lea Brothers & Co.'s Publications — Dis. of Women, Midwfy. 



EMMET, THOMAS ADDIS, M. !>., LL. !>., 

Surgeon to the Woman's Hospital, New York, etc. 

The Principles and Practice of Gynecology ; For the use of Students and 
Practitioners of Medicine. New (third) edition, thoroughly revised. In one large and very 
handsome octavo volume of 880 pages, with 150 illustrations. Cloth, $5 ; leather, $6 ; 
very handsome half Kussia. raised bands, $6.50. 
We are in doubt whether to congratulate the I the privilege thus offered them of perusing the 



author more than the profession upon the appear 
ance of the third edition of this well-known work 
Embodying, as it does, the life-long experience of 
one who has conspicuously distinguished himself 
as a bold and successful operator, and who has 
devoted so much attention to the specialty, we 
feel sure the profession will not fail to appreciate 



views and practice of the author. His earnestness 
of purpose and conscientiousness are manifest. 
He gives not only his individual experience but 
endeavors to represent the actual state of gyne- 
cological science and art. — British Medical Jour- 
nal, May 16, 1885. 



TAIT, LAWSOJST, F.B. C. S., 

Professor of Gynecology in Queen's College, Birmingham; late President of the British Gyne- 
cological Society ; Fellow American Gynecological Society. 

Diseases of Women and Abdominal Surgery. In two very handsome 
octavo volumes. Volume I., 554 pages, 62 engravings and 3 plates. Cloth, $3. Just 
ready. Volume II., preparing. 



The plan of the work does not indicate the regu- 
lar system of a text book, and yet nearly every- 
thing of disease pertaining to the various organs 
receives a fair consideration. The description of 
diseased conditions is exceedingly clear, and the 
treatment, medical or surgical, is very satisfactory. 



Much of the text is abundantly illustrated with 
cases, which add value in showing the results of 
the suggested plans of treatment. We feel con- 
fident that few gynecologists of the country will 
fail to place the work in their libraries. — The 
Obstetric Gazette, March, 1890. 



DAVEJSTPOBT, F. H., M. !>., 

Assistant in Gynecology in the Medical Department of Harvard University, Boston. 

Diseases of Women, a Manual of Non-Surgical Gynaecology. De- 
signed especially for the Use of Students and General Practitioners. In one handsome 
12mo. volume of 317 pages, with 105 illustrations. Cloth, $1.50. Just ready. 

# We agree with the many reviewers whose no- 
tices we have read in other journals congratulating 
Dr. Davenport on the success which he has 
attained. He has tried to write a book for the 
student and general practitioner which would 
tell them just what they ought to know without 
distracting their attention with a lot of compila- 
tions for which they could have no possible use. 
In this he has been eminently successful. There 
is not even a paragraph of useless matter. 



Everything is of the newest, freshest and most 
practical, so much so that we have recommended 
it to our class of gynecology students. What the 
author advises in the way of treatment has all 
been practically tested by himself, and each 
method receives only so much commendation as he 
has found that it deserves. We are sure that 
these good qualities will command for it a large 
sale.— Canada Medical Record, Dec. 1889. 



MAY, C SABLES H., M. !>., 

Late House Surgeon to Mount Sinai Hospital, New York. 
A Manual of theDiseases of Women. Being a concise and systematic expo- 
sition of the theory and practice of gynecology. New (2d) edition, edited by L. S. Eau, 
M. D., Attending Gynecologist at the Harlem* Hospital, 1ST. Y. In one 12mo. volume of 
360 page?, with 31 illustrations. Cloth, $1.75. Just ready. 

rapidly but has not the time to consult larger 
works. We are much struck with the readiness 
and convenience with which one can refer to any 
subject contained in this volume. _ Carefully com- 
piled indexes and ample illustrations also enrich 
the work. This manual will be found to fulfil its 
purposes very satisfactorily. — The Physician and 
Surgeon, June, 1890. 



This is a manual of gynecology in a very con- 
densed form, and the fact that a second edition 
has been called for indicates that it has met with 
a favorable reception. It is intended, the author 
tells us, to aid the student who after having care- 
fully perused larger works desires to review the 
subject, and he adds that it may be useful to the 
practitioner who wishes to refresh his memory 



DVJVCAN, J. MATTHEWS, M.I)., LL. JD., F. B. S. E., etc. 

Clinical Lectures on the Diseases of Women ; Delivered in Saint Bar- 
tholomew's Hospital. In one handsome octavo volume of 175 pages. Cloth, $1.50. 

They are in every way worthy of their author ; I rule, adequately handled in the text-books ; others 
indeed, we look upon them as among the most of them, while bearing upon topics that are usually 
valuable of his contributions. They are all upon I treated of at length in such works, yet bear such a 
matters of great interest to the general practitioner. I stamp of individuality that they deserve to be 
Some of them deal with subjects that are not, as a j widely read.— N. Y. Medical Journal, March, 1880. 



HODGE ON DISEASES PECULIAR TO WOMEN. 
Including Displacements of the Uterus. Second 
edition, revised and enlarged. In one beauti- 
fully printed octavo volume of 519 pages, with 
original illustrations. Cloth, $1.50. 

RAMSBOTHAM'S PRINCIPLES AND PRAC- 
TICE OF OBSTETRIC MEDICINE AND 
SURGERY. In reference to the Process of 
Parturition. A new and enlarged edition, thor- 
oughly revised by the Author. With additions 
by W. V. Keating, M. D., Professor of Obstetrics, 



etc., in the Jefferson Medical College of Phila- 
delphia. In one large and handsome imperial 
octavo volume of 640 pages, with 64 full page 
plates and 13 woodcuts in the text, containing in 
all nearly 200 beautiful figures. Strongly bound 
in leather, with raised bands, $7. 
WEST'S LECTURES ON THE DISEASES OP 
WOMEN Third American from the third Lon- 
don edition. In one octavo volume of 543 pages. 
Cloth, $3.75; leather, $4.75. 



Lea Brothers & Co.'s Publications — Midwifery. 



29 



BLAYFAIR, W. S., M. L>., F. R. C. P., 

Professor of Obstetric Medicine in King's College, London, etc. 

A Treatise on the Science and Practice of Midwifery. New (fifth) 
American, from the seventh English edition. Edited, with additions, by Kobert P. Har- 
ris, M. D. In one handsome octavo volume of 664 pages, with 207 engravings and 5 
Cloth, $4.00 ; leather, $5.00. Just ready. 

is perhaps the most popular work of its kind ever 
presented to the profession. Beginning with the 
anatomy and physiology of the organs concerned, 
nothing is left unwritten that the practical ac- 
coucheur should know. It seras that every 



Playfair's Midwifery has for many years been a 
favorite authority both among obstetric teachers 
and general practitioners of the obstetric art. A 
work of this kind having reached a fifth American 
from the seventh English edition would seem 
scarcely to require any extended notice. Of 
previous American editions the matter has been 
largely rewritten or remodelled, besides many 
new short notes have been added. For either the 
student or the old practitioner this work meets 
all needs; it is full and yet condensed ; it is clear 
and well arranged.— Obstetric Gazette, Nov., 1889. 

Truly a wonderful book; an epitome of all ob- 
stetrical knowledge, full, clear and concise. In 
thirteen years it has reached seven editions. It 



conceivable physiological or pathological condi- 
tion from the moment of conception to the time 
of complete involution has had the author's 
patient attention. The plates and illustrations, 
carefully studied, will teach the science of mid- 
wifery. The reader of this book will have before 
him the very latest and best of obstetric practice, 
and also of all the coincident troubles connected 
therewith.— Southern Practitioner, Dec, 1889. 



KING, A. F. A., M. B., 

Professor of Obstetrics and Diseases of Women in the Medical Department of the Columbian Univer- 
sity, Washington, D. C, and in the University of Vermont, etc. 

A Manual of Obstetrics. New (fourth) edition. In one very handsome 12mo. 
volume of 432 pages, with 140 illustrations. Cloth, $2.50. Just ready. 



Dr. King, in the preface to the first edition of 
this manual, modestly states that " its purpose is 
to furnish a good groundwork to the student at 
the beginning of his obstetric studies." Its pur- 
pose is attained ; it will furnish a good ground- 
work to the student who carefully reads it; and 
further, the busy practitioner should not scorn the 
volume because written for students, as it con- 
tains much valuable obstetric knowledge, some 
of which is not found in more elaborate text- 
books. The chapters on the anatomy of the 
female generative organs, mensti'uation, fecunda- 
tion, the signs of pregnancy, and the diseases of 
pregnancy, are all excellent and clear; but it is in 



the description of labor, both normal and abnor- 
mal, that Dr. King is at his best. Here his style 
is so concise, and the illustrations are so good, 
that the veriest tyro could not fail to receive a clear 
conception of labor, its complications and treat- 
ment. Of the 141 illustrations it may be safely 
said that they all illustrate, and that the engraver's 
work is excellent. The name of the publishers 
is a sufficient guarantee that the work is pre- 
sented in an attractive form, and from every 
standpoint we can most heartily recommend the 
book both to practitioner and student. — The Medi- 
cal News, Dec. 7, 1889. 



BARNES, ROBERT, M. B., and EANCOURT, M. B., 

Phys. to the General Lying-in LTosp., Lond. Obstetric Phys. to St. Thomas' Hosp., Lond. 

A System of Obstetric Medicine and Surgery, Theoretical and Clin- 
ical. For the Student and the Practitioner. The Section on Embryology by Prof. Milnes 
Marshall. In one 8vo. volume of 872 pp., with 231 illustrations. Cloth, $5 ; leather, $6. 

The immediate purpose of the work is to furnish 
a handbook of obstetric medicine and surgery 
for the use of the student and practitioner. It is 
not an exaggeration to say of the book that it is 
the best treatise in the English language yet 
published, and this will not be a surprise to those 
who are acquainted with the work of the elder 
Barnes. Every practitioner who desires to have 



the best obstetrical opinions of the time in a 
readily accessible and condensed form, ought to 
own a copy of the book. — Journal of the American 
Medical Association, June 12, 1886. 

The Authors have made a text-book which is in 
every way quite worthy to take a place beside the 
best treatises of the period. — New York Medical 
Journal, July 2, 1887. 



BARVIN, TIEEOBHILVS, M. B., LL. B., 

Prof, of Obstetrics and the Diseases of Women and Children in Jefferson Med. Coll., Phila. 
The Science and Art of Obstetrics. New (2d) edition. In one handsome 
8vo. volume of about 700 pages, with about 225 engravings and a colored plate. Shortly. 



BARKER, FORJDYCF, A. M., M. B. 9 LL. B. Edin., 

Clinical Professor of Midwifery and the Diseases of Women in the Bellevue Hospital Medical College, 
New York, Honorary Fellow of the Obstetrical Societies of London and Edinburgh, etc., etc. 

Obstetrical and Clinical Essays. 12mo., about 300 pages. Preparing. 



PARRY, JOHN S., M. L>., 

Obstetrician to the Philadelphia Hospital, Vice-President of the Obstet. Society of Philadelphia. 
Extra - Uterine Pregnancy: Its Clinical History, Diagnosis, Prognosis and 
Treatment. In one handsome octavo volume of 272 pages. Cloth, $2.50. 



WINCKEL, F. 

A Complete Treatise on the Pathology and Treatment of Childbed, 

For Students and Practitioners. Translated, with the consent of the Author, from the 
second German edition, by J. E. Chadwick, M. D. Octavo 484 pages. Cloth, $4.00. 



ASHWELL'S PRACTICAL TREATISE ON THE 
DISEASES PECULIAR TO WOMEN. Third 
American from the third and revised London 
edition. In one 8vo. vol., pp. 520. Cloth, $3.50. 

TANNER ON PREGNANCY. Octavo, 490 pages, 
colored plates, 16 cuts. Cloth, $4.25. 



CHURCHILL ON THE PUERPERAL FEVER 
AND OTHER DISEASES PECULIAR TO WO- 
MEN. In one 8vo. vol. of 464 pages. Cloth, $2.50. 

MEIGS ON THE NATURE, SIGNS AND TREAT- 
MENT OF CHILDBED FEVER. In one 8vo. 
volume of 346 pages. Cloth, $2.00. 



30 



Lea Brothers & Co.'s Publications — Midwfy., Dis. Childn. 



LEISHMAJST, WILLIAM, M. !>., 

Regius Professor of Midwifery in the University of Glasgow, etc. 

A System of Midwifery, Including the Diseases of Pregnancy and the 
Puerperal State. Third American edition, revised by the Author, with additions by 
John S. Parry, M. D., Obstetrician to the Philadelphia Hospital, etc. In one large and 
very handsome octavo volume of 740 pages, with 205 illustrations. Cloth, $4.50 ; leather, 
$5.50. 



The author is broad in his teachings, and dis- 
cusses briefly the comparative anatomy of the pel- 
vis and the mobility of the pelvic articulations. 
The second chapter is devoted especially to 
the study of the pelvis, while in the third the 
female organs of generation are introduced. 
The structure and development of the ovum are 
admirably described. Then follow chapters upon 
the various subjects embraced in the study of mid- 
wifery. The descriptions throughout the work are 
f>lain and pleasing. It is sufficient to state that in 
his, the last edition of this well-known work, every 
recent advancement in this field has been brought 
forward. — Physician and Surgeon, Jan. 1880. 
To the American student the work before us 



must prove admirably adapted. Complete in all its 
parts, essentially modern in its teachings, and with 
demonstrations noted for clearness and precision, 
it will gain in favor and be recognized as a work 
of standard merit. The work cannot fail to be 
popular and is cordially recommended.— N. O. 
Med. and Surg. Journ., March, 1880. 

It has been well and carefully written. The 
views of the author are broad and liberal, and in- 
dicate a well-balanced judgment and matured 
mind. We observe no spirit of dogmatism, but 
the earnest teaching of the thoughtful observer 
and lover of true science. Take the volume as a 
whole, and it has few equals.— Maryland Medical 
Journal, Feb. 1880. 



LANDIS, MENBY G., A. M., M. I>., 

Professor of Obstetrics and the Diseases of Women in Starling Medical College, Columbus, O. 

The Management of Labor, and of the Lying-in Period. In one 

handsome 12mo. volume of 334 pages, with 28 illustrations. Cloth, $1.75. 

tempt any one who should happen to commence 
the book to read it through: The author pre- 
supposes a theoretical knowledge of obstetrics, 
and has consistently excluded from this little 



The author has designed to place in the hands 
of the young practitioner a book in which he can 
find necessary information in an instant. As far 
as we can see, nothing is omitted. The advice is 
sound, and the proceedures are safe and practical. 
Centralblatt fur Gynakologie, December 4, 1886. 

This is a book we can heartily recommend, 
the author goes much more practically into the 
details of the management of labor than most 
text-books, and is so readable throughout as to 



work everything that is not of practical use in the 
lying-in room. We think that if it is as widely 
read as it deserves, it will do much to improve 
obstetric practice in general. — New Orleans Medi- 
cal and Surgical Journal, Mar. 1886. 



SMITH, J. LEWIS, M. I)., 

Clinical Professor of Diseases of Children in the Bellevue Hospital Medical College, N. Y. 

A Treatise on the Diseases of Infancy and Childhood. New (sixth) 
edition, thoroughly revised and rewritten. In one handsome octavo volume of 867 
pages, with 40 illustrations. Cloth, $4.50 ; leather, $5.50. 



For years it has stood high in the confidence of 
the profession, and with the additions and alter- 
ations now made it may be said to be the best 
book in the language on the subject of which it 
treats. An examination of the text fully sus- 
tains the claims made in the preface, that "in 
preparing the sixth edition the author has revised 
the text to such an extent that a considerable 
part of the book may be considered new." If the 
young practitioner proposes to place in his library 
but one book on the diseases of children, we 
would unhesitatingly say, let that book be the one 
which is the subject of this notice. — The American 
Journal of the Medical Sciences, April, 1886. 

No better work on children's diseases could be 
placed in the hands of the student, containing, as 
it does, a very complete account of the symptoms 
and pathology of the diseases of early life, and 
possessing the further advantage, in which it 
stands alone amongst other works on its subject, 
of recommending treatment in accordance with 
the most recent therapeutical views. — British and 
Foreign Medico-Chirurgical Review. 

Those familiar with former editions of the work 



will readily recognize the painstaking with which 
this revision has been made. Many of the articles 
have been entirely rewritten. The whole work is 
enriched with a research and reasoning which 
plainly show that the author has spared neither 
time nor labor in bringing it to its present ap- 
proach towards perfection. The extended table of 
contents and the well-prepared index will enable 
the busy practitioner to reach readily and quickly 
for reference the various subjects treated of in the 
body of the work, and even those who are familiar 
with former editions will find the improvements 
in the present richly worth the cost of the work.— 
Atlanta Medical and Surgical Journal, Dec. 1886. 

Dr. Smith's work has justly become the standard 
all over the world as the book on children's dis- 
eases The whole book is admirable, both for the 
practitioner and the student. Dr. Smith writes 
from a large experience and a close observation 
of cases at the bedside. He is extremely prac- 
tical, and these facts make the work what it is— 
the best of all works on the diseases of children. 
— Virginia Medical Monthly, June, 1886. 



OWEN, EDMUND, M. B., F. B. C. S., 

Surgeon to the Children's Hospital, Great Ormond St., London. 



Surgical Diseases of Children. 

chromo-lithographic plates and 85 woodcuts 
page 31. 

One is immediately struck on reading this book 
with its agreeable style and the evidence it every- 
where presents of the practical familiarity of its 
author with his subject. The book may be 



In one 12mo. volume of 525 pages, with 4 
Cloth, $2. See Series of Clinical Manuals, 

honestly recommended to both students and 
practitioners. It is full of sound information, 
pleasantly given.— Annals of Surgery, May, 1886. 



WEST, CHABLES, M. D., 

Physician to the Hospital for Sick Children, London, etc , 

On Some Disorders of the Nervous System in Childhood. In one small 
12mo. volume of 127 pages. Cloth, $1.00. 

In one octavo volume of 



CONDIE'S PKACTICAL TREATISE ON THE 
DISEASES OF CHILDREN. Sixth edition, re- 



vised and augmented. 

779 pages. Cloth, $5.25; leather, $6.25. 



Lea Brothers & Co.'s Publications — Med. Juris., Miscel. 31 

TIDY, CMABLES MEYMOTT, M. B., F. C. S., 

Professor of Chemistry and of Forensic Medicine and Public Health at the London Hospital, etc. 

Legal Medicine. Volume II. Legitimacy and Paternity, Pregnancy, Abor- 
tion, Bape, Indecent Exposure, Sodomy, Bestiality, Live Birth, Infanticide, Asphyxia, 
Drowning, Hanging, Strangulation, Suffocation. Making a very handsome imperial oc- 
tavo volume of 529 pages. Cloth, $6.00 ; leather, $7.00. 

Volume I. Containing 664 imperial octavo pages, with two beautiful colored 
plates. Cloth, $6.00 ; leather, $7.00. 

The satisfaction expressed with the first portion tables of cases appended to each division of the 
of this work is in no wise lessened by a perusal of subject must have cost the author a prodigious 
the second volume. We find it characterized by amount of labor and research, but they constitute 
the same fulness of detail and clearness of ex- one of the most valuable features of the book, 
pression which we had occasion so highly to com- especially for reference in medico-legal trials. — 
mend in our former notice, and which render it so American Journal of the Medical Sciences, April, 1884. 
valuable to the medical jurist. The copious 



TAYLOR, ALFBEJD S., M. !>., 

Lecturer on Medical Jurisprudence and Chemistry in Guy's Hospital, London. 

Poisons in Relation to Medical Jurisprudence and Medicine. Third 
American, from the third and revised English edition. In one large octavo volume of 788 
pages. Cloth, $5.50 ; leather, $6.50. 

By the Same Author. 
A Manual of Medical Jurisprudence. Eighth American from the tenth Lon- 
don edition, thoroughly revised and rewritten. Edited by John J. Eeese, M. D. In one 
large octavo volume. 

JPEBBEB, AUGUSTUS J., M. 8., M. B., F. B. C. S., 

Examiner in Forensic Medicine at the University of London. 
Forensic Medicine. In one pocket-size 12mo. volume. Preparing. See Students 1 
Series of Manuals, below. 

STUDENTS' SEBIES OF MANUALS. 

A Series of Fifteen Manuals, for the use of Students and Practitioners of Medicine and Surgery, 
written by eminent Teachers or Examiners, and issued in pocket-size 12mo volumes of 300-540 pages, 
richly illustrated and at a low price. The following volumes are now ready: Treves' Manual of Sur- 
gery, by various writers, in three volumes, each, $2; Bell's Comparative Physio ogy and Anatomy, $2; 
Gould's Surgical Diagnosis. $2; Robertson's Physiological Physics, $2; Bruce's Materia Medica and Thera- 
peutics (4th edition), $1.50; Power's Human Physiology (2d edition), $1.50; Clarke and Lockwood's 
Dissectors' 1 Manual, $1.50; Ralfe's Clinical Chemistry, $1.50; Treves' Surgical Applied Anatomy, $2; 
Pepper's Surgical Pathology, $2 ; and Klein's Elements of Histology (4th edition), $1.75. The following 
is in press : Pepper's Forensic Medicine. For separate notices see index on last page. 



SEBIES OF CLINICAL MANUALS. 

In arranging for this Series it has been the design of the publishers to provide the profession with 
a collection of authoritative monographs on important clinical subjects in a cheap and portable form. 
The volumes will contain about 550 pages and will be freely illustrated by chromo-lithographs and wood- 
cuts. The following volumes are now ready: Yeo on Food in Health and Disease, $2; Broadbent on 
the Pulse, $1.75; Carter & Frost's Ophthalmic Surgery, $2.25; Hutchinson on Syphilis, $2.25; Ball on 
the Rectum and Anus, $2.25 ; Marsh on the Joints, $2 ; Owen on Surgical Diseases of Children, $2 ; 
Morris on Surgical Diseases of the Kidney, $2.25 ; Pick on Fractures and Dislocations, $2; Butlin on 
the Tongue, $3.50; Treves on Intestinal Obstruction, $2; and Savage on Insanity and A Hied Neuroses, $2. 
The following is in active preparation: Lucas on Diseases of the Urethra. For separate notices see 
index on last page. 

LEA, SENBY C. 

Chapters from the Religious History of Spain.— Censorship of th© 
Press. — Mystics and Illuminati.— The Endemoniadas of Queretaro. — 
El Santo Nino de la Guardia.— Brianda de Bardaxi. In one 12mo. volume 
of about 500 pages. In press. 

In making researches for a History of the Spanish Inquisition the author has been 
led to investigate various subjects deserving of treatment more elaborate than could be 
accorded to them in a continuous narrative. These he has worked out in the present vol- 
ume in the hope that beside the intrinsic interest of the themes themselves, they may 
serve to explain some of the causes which reduced to impotence a nation that in the 
sixteenth century aspired to universal monarchy. 

* By the same Author. 
Superstition and Force : Essays on The Wager of Law, The Wager of 
Battle, The Ordeal and Torture. Third revised and enlarged edition. In one 
handsome royal 12mo. volume of 552 pages. Cloth, $2.50. 

By the Same Author. 
Studies in Church History. The Rise of the Temporal Power— Ben- 
efit of Clergy — Excommunication. New edition. In one very handsome royal 
octavo volume of 605 pages. Cloth, $2.50. 



Allen's Anatomy .... 

American Journal of the Medical Sciences 

American Systems of Gynecology and Obstetrics 

American System of Practical Medicine . 

American System of Dentistry 

Ashhurst's Surgery .... 

Ashwell on Diseases of Women 

Attfield's Chemistry .... 

Ball on the Rectum and Anus 

Barker's Obstetrical and Clinical Essays, 

Barlow's Practice of Medicine 

Barnes' System of Obstetric Medicine 

Bartholow on Electricity 

Basham on Renal Diseases . 

Bell's Comparative Physiology and Anatomy 

Bellamy's Surgical Anatomy 

Berry on the Eye .... 

Billings' National Medical Dictionary . 

Blandford on Insanity 

Bloxam's Chemistry . . . 

Bristowe's Practice of Medicine 

Broadbent on the Pulse 

Browne on the Throat, Nose and Ear 

Bruce's Materia Medica and Therapeutics 

Brunton's Materia Medica and Therapeutics 

Bryant's Practice of Surgery . 

Bumstead and Taylor on Venereal. See Taylor 

Burnett on the Ear .... 

Butlin on the Tongue .... 

Carpenter on the Use and Abuse of Alcohol 

Carpenter's Human Physiology 

Carter & Frost's Ophthalmic Surgery 

Chambers on Diet and Regimen 

Chapman's Human Physiology 

Charles' Physiological and Pathological Chem 

Churchill on Puerperal Fever 

Clarke and Lockwood's Dissectors' Manual 

Classen's Quantitative Analysis 

Cleland's Dissector .... 

Clouston on Insanity .... 

Clowes' Practical Chemistry 

Coats' Pathology . 

Cohen on the Throat .... 

Coleman's Dental Surgerv . 

Condie on Diseases of Children 

Cornii on Syphilis .... 

Dalton on the Circulation 

Dalton's HumanPhysiology 

Davenport on Diseases of Women . 

Davis' Clinical Lectures 

Draper's Medical Physics 

Druitt's Modern Surgery 

Duncan on Diseases of Women 

Dungllson's Medical Dictionary 

Edes' Materia Medica and Therapeutics 

Edis on Diseases of Women . 

Ellis' Demonstrations of Anatomy 

Emmet's Gynaecology 

Erichsen's System of Surgery 

Farquharson's Therapeutics and Mat. Med. 

Fenwick's Medical Diagnosis 

Finlayson's Clinical Diagnosis 

Flint on Auscultation and Percussion 

Flint on Phthisis .... 

Flint on Respiratory Organs 

Flint on the Heart .... 

Flint's Essays ..... 

Flint's Practice of Medicine 

Folsom's Laws of U. S. on Custody of Insane 

Foster's Physiology .... 

Fothergill's Handbook of Treatment 

Fownes' Elementary Chemistry . 

Fox on Diseases of the Skin . 

Frankland and Japp's Inorganic Chemistry 

Fuller on the Dungs and Air Passages 

Gant's Student's Surgery 

Gibney's Orthopaedic Surgery 

Gould's Surgical Diagnosis . 

Gray's Anatomy ..... 

Greene's Medical Chemistry . 

Green's Pathology and Morbid Anatomy 

Griffith's Universal Formulary 

Gross on Foreign Bodies in Air-Passages 

Gross on Impotence and Sterility . 

Gross on Urinary Organs 

Gross System of Surgery 

Habershon on the Abdomen 

Hamilton on Fractures and Dislocations 

Hamilton on Nervous Diseases 

Hare's Practical Therapeutics 

Hartshorne's Anatomy and Physiology . 

Hartshorne's Conspectus of the Med. Sciences 

Hartshorne's Essentials of Medicine 

Hermann's Experimental Pharmacology 

Hill on Syphilis ..... 

Hillier's Handbook of Skin Diseases 

Hoblyn's Medical Dictionary 

Hodge on Women .... 

Hoffmann and Power's Chemical Analysis 

Holden's Landmarks .... 

Holland's Medical Notes and Reflections 

Holmes' Principles and Practice of Surgery 

Holmes' System of Surgery 

Horner's Anatomy and Histology 

Hudson on Fever 

Hutchinson on Syphilis 

Hyde on the Diseases of the Skin . 

Jones (C. Handheld) on Nervous Disorders 



Juler's Ophthalmic Science and Practice 

King's Manual of Obstetrics . 

Klein's Histology .... 

Landis on Labor .... 

La Roche on Pneumonia, Malaria, etc. . 

La Roche on Yellow Fever . 

Laurence and Moon's Ophthalmic Surgery 

Lawson on the Eye, Orbit and Eyelid 

Lea's Chapters from Religious History of Spain 

Lea's Studies in Church History 

Lea's Superstition and Force 

Lee on Syphilis . . 

Lehmann f s Chemical Physiology . 

Leishman's Midwifery 

Lucas on Diseases of the Urethra . 

Ludlow's Manual of Examinations 

Lyons on Fever ..... 

Maisch's Organic Materia Medica . 

Marsh on the Joints 

May on Diseases of Women . 

Medical News 

Medical News Visiting List . 

Medical News Physicians' Ledger . 

Meigs on Childbed Fever 

Miller's Practice of Surgery . 

Miller's Principles of Surgery 

Mitchell's Nervous Diseases of Women . 

Morris on Diseases of the Kidney . 

National Dispensatory 

National Medical Dictionary 

Neill and Smith's Compendium of Med. Sci. 

Nettleship on Diseases of the Eye . 

Norris and Oliver on the Eye 

Owen on Diseases of Children 

Parrish's Practical Pharmacy . . 

Parry on Extra-Uterine Pregnancy 

Parvin's Midwifery .... 

Pavy on Digestion and its Disorders 

Payne's General Pathology . 

Pepper's System of Medicine 

Pepper's Forensic Medicine . 

Pepper's Surgical Pathology 

Pick on Fractures and Dislocations 

Pirrie's System of Surgery . 

Playfair on Nerve Prostration and Hysteria 

Playfair's Midwifery .... 

Politzer on the Ear and its Diseases 

Power's Human Physiology . 

Purdy on Bright's Disease and Allied A flections 

Ralfe's Clinical Chemistry 

Ramsbotham on Parturition 

Remsen's Theoretical Chemistry . 

Reynolds' System of Medicine 

Richardson's Preventive Medicine 

Roberts on Urinary Diseases 

Roberts' Compend of Anatomy . 
Roberts' Surgery .... 

Robertson's Physiological Physics 

Ross on Nervous Diseases 

Savage on Insanity, including Hysteria . 

Schafer's Essentials of Histology, 

Schreiber on Massage . 

I Seiler on the Throat. Nose and Naso-Pharynx 

j Senn's Surgical Bacteriology 

Series of Clinical Manuals 

Simon's Manual of Chemistry 

Slade on Diphtheria .... 

Smith (Edward) on Consumption . 

Smith (J. Lewis) on Children 

Smith's Operative Surgery . 

Stllle on Cholera .... 

Stille" & Maisch's National Dispensatory 

Stmt's Therapeutics and Materia Medica 
Stimson on Fractures and Dislocations 
Stimson's Operative Surgery 

i Students' Series of Manuals . 

i Sturges' Clinical Medicine . 
Tait's Diseases of Women and Abdom. Surgery 

l Tanner on Signs and Diseases of Pregnancy 

i Tanner's Manual of Clinical Medicine . 
Taylor's Atlas of Venereal and Skin Diseases 
Taylor on Venereal Diseases 
Taylor on Poisons .... 

Taylor's Medical Jurisprudence 
Thomas on Diseases of Women 
Thompson on Stricture 
Thompson on Urinary Organs 
Tidy's Legal Medicine . 
Todd on Acute Diseases 
Treves' Manual of Surgery . 
6 I Treves' Surgical Applied Anatomy 
3 Treves on Intestinal Obstruction . 
14 Tuke on the Influence of Mind on the Body 
11 Vaughan & Novy's Ptomaines and Leucomaines 

25 Visiting List, The Medical News . 

26 Walshe on the Heart .... 

3 Watson's Practice of Physic . 
28 Wells on the Eye .... 
10 West on Diseases of Women 

5 West on Nervous Disorders in Childhood 
17 i Williams on Consumption . 
22 | Wilson's Handbook of Cutaneous Medicine 
22 Wilson's Human Anatomy . 

6 Winckel on Pathol, and Treatment of Childbed 

4 Wohler's Organic Chemistry 
25,31 Woodhead's Practical Pathology . 

26 Year-Books of Treatment for 1886, '87, '89 and 
19 Yeo on Food in Health and Disease 



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LEA BROTHERS & CO., Philadelphia. 



